Internal Medicine Review ABIM part 1
questions with correct answers
painless jaundice
- pruritus
- associated weight loss
- CA19-9 elevated - CORRECT ANSWERS-Cholangiocarcinoma
- primary sclerosing cholangitis
- ulcerative colitis
- intrahepatic bile duct stones
- liver fluke infections
"_____ is the itch that rashes" - CORRECT ANSWERS-Atopic Dermatitis (Eczema)
Flexural areas in adult
Tx: Stop scratching -- Hydroxyzine or Benadryl
"Wet" the skin with emollients
mild/moderate: topical pimecrolimus or tacrolimus and emollients
severe: topical glucocorticoids + topical pimecrolimus or tacrolimus and emollients
"Wisk thorough the EXIT"-
Eczema
X-linked
Immune deficiency
Thrombocytopenia - CORRECT ANSWERS-Wiskott-Aldrich syndrome
Low IgM, elevated IgA, IgE
Rx- BM transplant
>60yo, Autoimmune disorder
Pruritic bullae on erythematous base;
axilla, medial thigh and groin, abdomen, forearm flexor surface, or lower legs." -
CORRECT ANSWERS-Bullous pemphigoid
Systemic prednisone + azathioprine
,IV immunoglobulins
plasmapheresis if needed
1 non-villous adenoma <10mm,
low-grade dysplasia.
when should follow C-scope be done? - CORRECT ANSWERS-5-10 years
1. Hypotension and muffled heart sounds
2. Pulsus paradoxus
3. JVD with no collapse during diastole - CORRECT ANSWERS-pericardial tamponade
CT or MRI are better than echo, and
can see small pockets of fluid
Surgery if:
traumatic hemopericadium,
post surgical effusion,
bacteria or TB suspected as cause
24yo with heavy menses and epistaxis.
Normal PT, PTT, CBC. - CORRECT ANSWERS-von Willebrands disease
next step is PFA100/bleeding time
3 extra-intestinal manifestations that have
NO effect on IBD severity? - CORRECT ANSWERS-Primary sclerosing cholangitis
Axial Arthropathy
Uveitis
3-10 adenomas
adenoma > 10mm
Any villous adenoma
Any adenoma with high grade dysplasia
When to repeat C-scope? - CORRECT ANSWERS-3 years
40F with DM: leg rash.
Scaly erosions, sclerosis, and
slight bronze-orange pigmentation - CORRECT ANSWERS-Stasis Dermatitis
hemoglobin deposits cause pigmentation
topical glucocorticoids (short term)
for secondary infections, topical antibiotics (Mupirocin)
70yo LLQ pain,
fever and leukocytosis.
Diagnosed with diverticulitis and
treated with Cipro and Flagyl.
,What follow up test must be done? - CORRECT ANSWERS-Flex sig/C-scope in 4-8
weeks after acute condition resolves
as sigmoid CA can present similarly to diverticulitis
70yo pancytopenic
Ret count 0.4%.
Basophilic stippling and dimorphic population.
What is next step? What is likely dx? - CORRECT ANSWERS-Bone marrow bx
(HYPERcellular, ringed sideroblasts, dysplastic cells)
Myelodysplasia
Usually in elderly (may only have one or two dysplasias)
A patient presents with itching of the back and sides of her scalp. There is a current
outbreak of head lice in her classroom, but you can't see any nits with the naked eye.
You pull out your ____ _____ to see them, because any nits in the hair will fluoresce
under special lighting. - CORRECT ANSWERS-Wood's Lamp
Tx: permethrin
malathione
A patient taking an antibiotic for an infection has developed painful lesions on his hands
and face.
target-like lesion
(papule with vesicles and bullae in the center)
Fever and weakness. - CORRECT ANSWERS-Erythema multiforme due to drug
reaction
A young male who has recently been treated for a viral infection has developed a
single, oval, slightly raised plaque that is salmon-red - CORRECT ANSWERS-Pityriasis
rosea
HHV 6 or 7 (herpes virus)
next: exanthematous eruption -- fine scaling dull pink/tawny papules and plaques
erupting in a Christmas tree pattern. Itchy
Antihistamines for itching
topical glucocorticoids
may be improved by UVB/sunlight therapy
Abd pain out of proportion to physical findings.
Usually after eating a meal.
wt loss over past several weeks.
Abdominal bruit. - CORRECT ANSWERS-LIkely has chronic mesenteric ischemia
Dx: Order MRA or CTA of abd
Tx: surgical bypass or angioplasty
, Abd pain, diarrhea in 27yo.
No bleeding.
heavy smoker.
Has mother with same sx.
Colonoscopy shows patchy ulcerations colon, but nothing in rectum. - CORRECT
ANSWERS-Crohn's disease
- rectal sparing
- skip lesions (intermittent normal colon)
- String sign= ileal disease on UGI study
- Can have diease anywhere in GI tract (mouth, anus, stomach and duodnum included)
- small bowel involved >50%
- ASCA
Abdominal thrombosis of some sort.
Hemolytic type picture (elev bili, inc LDH).
WBC and plts normal.
What is next test? What is likely dx? - CORRECT ANSWERS-Paroxysmal Nocturnal
Hemoglobinuria
Test: flow cytometry- shows decrease in DAF (CD55) and HRF (CD59)
May transform into aplastic anemia, acute leukemia, myelofibrosis
Acanthosis nigricans is associated with cancer in what organ? - CORRECT ANSWERS-
Stomach
ACC/AHA stage A CHF - definition, goal, meds - CORRECT ANSWERS-Def: at risk for
HF - includes
HTN, ASHD, DM, metabolic syndrome,
cardiotoxins, FH of cardiomyopathy
Goal - treat disorder, exercise,
discourage alcohol/ illicit drug use
Drugs - ACE/ARB for all
ACC/AHA stage B - definition, goal, meds - CORRECT ANSWERS-Def - structural HD,
no s/sx of HF - includes prior MI, LV remodeling from LVH, low EF, asx valvular dz
Goals - same as stage A
Tx - ACE/ARB + B-blockers, ICD if indicated
ACC/AHA stage C - definition, goal, meds - CORRECT ANSWERS-Def - structural HD
with s/sx HF - dyspnea, fatigue, decreased exercise tolerance
Goals - like A/B, add dietary salt restriction
Rx - ACE/ARB + BB + diuretics.
May need aldactone, ARBs with ACE, dig, hydralazine/nitrate combo.
questions with correct answers
painless jaundice
- pruritus
- associated weight loss
- CA19-9 elevated - CORRECT ANSWERS-Cholangiocarcinoma
- primary sclerosing cholangitis
- ulcerative colitis
- intrahepatic bile duct stones
- liver fluke infections
"_____ is the itch that rashes" - CORRECT ANSWERS-Atopic Dermatitis (Eczema)
Flexural areas in adult
Tx: Stop scratching -- Hydroxyzine or Benadryl
"Wet" the skin with emollients
mild/moderate: topical pimecrolimus or tacrolimus and emollients
severe: topical glucocorticoids + topical pimecrolimus or tacrolimus and emollients
"Wisk thorough the EXIT"-
Eczema
X-linked
Immune deficiency
Thrombocytopenia - CORRECT ANSWERS-Wiskott-Aldrich syndrome
Low IgM, elevated IgA, IgE
Rx- BM transplant
>60yo, Autoimmune disorder
Pruritic bullae on erythematous base;
axilla, medial thigh and groin, abdomen, forearm flexor surface, or lower legs." -
CORRECT ANSWERS-Bullous pemphigoid
Systemic prednisone + azathioprine
,IV immunoglobulins
plasmapheresis if needed
1 non-villous adenoma <10mm,
low-grade dysplasia.
when should follow C-scope be done? - CORRECT ANSWERS-5-10 years
1. Hypotension and muffled heart sounds
2. Pulsus paradoxus
3. JVD with no collapse during diastole - CORRECT ANSWERS-pericardial tamponade
CT or MRI are better than echo, and
can see small pockets of fluid
Surgery if:
traumatic hemopericadium,
post surgical effusion,
bacteria or TB suspected as cause
24yo with heavy menses and epistaxis.
Normal PT, PTT, CBC. - CORRECT ANSWERS-von Willebrands disease
next step is PFA100/bleeding time
3 extra-intestinal manifestations that have
NO effect on IBD severity? - CORRECT ANSWERS-Primary sclerosing cholangitis
Axial Arthropathy
Uveitis
3-10 adenomas
adenoma > 10mm
Any villous adenoma
Any adenoma with high grade dysplasia
When to repeat C-scope? - CORRECT ANSWERS-3 years
40F with DM: leg rash.
Scaly erosions, sclerosis, and
slight bronze-orange pigmentation - CORRECT ANSWERS-Stasis Dermatitis
hemoglobin deposits cause pigmentation
topical glucocorticoids (short term)
for secondary infections, topical antibiotics (Mupirocin)
70yo LLQ pain,
fever and leukocytosis.
Diagnosed with diverticulitis and
treated with Cipro and Flagyl.
,What follow up test must be done? - CORRECT ANSWERS-Flex sig/C-scope in 4-8
weeks after acute condition resolves
as sigmoid CA can present similarly to diverticulitis
70yo pancytopenic
Ret count 0.4%.
Basophilic stippling and dimorphic population.
What is next step? What is likely dx? - CORRECT ANSWERS-Bone marrow bx
(HYPERcellular, ringed sideroblasts, dysplastic cells)
Myelodysplasia
Usually in elderly (may only have one or two dysplasias)
A patient presents with itching of the back and sides of her scalp. There is a current
outbreak of head lice in her classroom, but you can't see any nits with the naked eye.
You pull out your ____ _____ to see them, because any nits in the hair will fluoresce
under special lighting. - CORRECT ANSWERS-Wood's Lamp
Tx: permethrin
malathione
A patient taking an antibiotic for an infection has developed painful lesions on his hands
and face.
target-like lesion
(papule with vesicles and bullae in the center)
Fever and weakness. - CORRECT ANSWERS-Erythema multiforme due to drug
reaction
A young male who has recently been treated for a viral infection has developed a
single, oval, slightly raised plaque that is salmon-red - CORRECT ANSWERS-Pityriasis
rosea
HHV 6 or 7 (herpes virus)
next: exanthematous eruption -- fine scaling dull pink/tawny papules and plaques
erupting in a Christmas tree pattern. Itchy
Antihistamines for itching
topical glucocorticoids
may be improved by UVB/sunlight therapy
Abd pain out of proportion to physical findings.
Usually after eating a meal.
wt loss over past several weeks.
Abdominal bruit. - CORRECT ANSWERS-LIkely has chronic mesenteric ischemia
Dx: Order MRA or CTA of abd
Tx: surgical bypass or angioplasty
, Abd pain, diarrhea in 27yo.
No bleeding.
heavy smoker.
Has mother with same sx.
Colonoscopy shows patchy ulcerations colon, but nothing in rectum. - CORRECT
ANSWERS-Crohn's disease
- rectal sparing
- skip lesions (intermittent normal colon)
- String sign= ileal disease on UGI study
- Can have diease anywhere in GI tract (mouth, anus, stomach and duodnum included)
- small bowel involved >50%
- ASCA
Abdominal thrombosis of some sort.
Hemolytic type picture (elev bili, inc LDH).
WBC and plts normal.
What is next test? What is likely dx? - CORRECT ANSWERS-Paroxysmal Nocturnal
Hemoglobinuria
Test: flow cytometry- shows decrease in DAF (CD55) and HRF (CD59)
May transform into aplastic anemia, acute leukemia, myelofibrosis
Acanthosis nigricans is associated with cancer in what organ? - CORRECT ANSWERS-
Stomach
ACC/AHA stage A CHF - definition, goal, meds - CORRECT ANSWERS-Def: at risk for
HF - includes
HTN, ASHD, DM, metabolic syndrome,
cardiotoxins, FH of cardiomyopathy
Goal - treat disorder, exercise,
discourage alcohol/ illicit drug use
Drugs - ACE/ARB for all
ACC/AHA stage B - definition, goal, meds - CORRECT ANSWERS-Def - structural HD,
no s/sx of HF - includes prior MI, LV remodeling from LVH, low EF, asx valvular dz
Goals - same as stage A
Tx - ACE/ARB + B-blockers, ICD if indicated
ACC/AHA stage C - definition, goal, meds - CORRECT ANSWERS-Def - structural HD
with s/sx HF - dyspnea, fatigue, decreased exercise tolerance
Goals - like A/B, add dietary salt restriction
Rx - ACE/ARB + BB + diuretics.
May need aldactone, ARBs with ACE, dig, hydralazine/nitrate combo.
