Internal Medicine Shelf QUESTIONS
AND ANSWERS Verified Solutions A
Bilateral Hilar Adenopathy - ANSWER -think Sarcoidosis!! (non caseasting granulomas,
interstitial lung disease, hypercalcemia and erythema nodosum)
Asbestosis: 1) location in lung 2) type of cancer risk 3) gross physical findings 4) histo findings
5) at risk population - ANSWER -*LOWER lobes
*mesothelioma & bronchogenic carcinoma
*pleural calcifications (plaques)
*asbestosis fiber=dumb bell
*shipyard workers, insulation, brake lining
Patient is a sand blaster/miner/glass or pottery worker...at risk for what lung disease? - ANSWER
-SILICOSIS-Fibrosis of UPPER lobes of lungs
What are patients with Silicosis at risk for? - ANSWER -Pulmonary TB (b/c of egg shell
calcifications of upper lung fields provide "nest" for TB)
COAL Miner's Disease - ANSWER -*IgA and IgG increased with decreased C3
* positive ANA
*small round nodular densities
*"CAPLAN SYNDROME"if with RA of lung
PULMONARY HYPERTENSION IS DEFINED AS: - ANSWER -PULMONARY ARTERY
PRESSURE >25MMHG OR >35MMHG DURING EXCERCISE (nml: 10-14mmHg)
What are results of Pulmonary Hypertension? - ANSWER -Atherosclerosis, intimal fibrosis of
pulmonary arteries
,Treatment for Pulmonary Hypertension? - ANSWER -1st: IV prostacyclins or other
VASODILATORS (adenosine, NO)
2nd: Calcium Channel Blocker
3rd: for Thromboprophylaxis: Warfarin
2ndary causes of Pulmonary Hypertension - ANSWER -1) COPD
2) Mitral Stenosis
3) Systemic Sclerosis (Scleroderma)
4) L-->R shunt (ASD/VSD)
5) Sleep Apnea or High altitude
6) Recurrent Thromboembolism
First step in Diagnosing Pulmonary Hypertension - ANSWER -Echo and Swan Ganz Catheter
(shows RVH and high PAP)
Besides ECHO and Swan Ganz Cath- Other diagnostic findings in Pulmonary Hypertension -
ANSWER -EKG-Rt axis deviation, evidence of RVH and RA enalrgement
Labs-polycythemia
Common respiratory conditions in HIV patients - ANSWER -1) CD4<200, Penuomocystic
Jiroveci
2) CD4<50 Mycobacterium Avium-intracellulare
3) CMV - intranuclear inclusion bodies
4) Aspergillosis fumigatus-pleuritic pain, hemoptysis, infiltrates on imaging
only 2 rx that are proven to reduce MORBIDITY and MORTALITY in COPD patients: -
ANSWER -1) O2 therapy (if o2 sat<88%, PaO2 is <55 or <60 w/ cor pulmonale)
2) Smoking Cessation
, Coal Minder Patient - ANSWER -SILICOSIS---patient should be tested for TB!!!
X-ray shows flattened diaphragm - ANSWER -COPD
Midsystolic Click and late systolic murmur indicative of.... - ANSWER -Mitral Valve Prolapse
Mitral Valve Stenosis is most commonly caused by... - ANSWER -Rheumatic Fever (secondary
to strep infection causing X rxn with valve)
Most common complications of Mitral valve stenosis - ANSWER -Atrial Fibrillation and
Pulmonary Edema
Clinical presentations of Mitral Stenosis - ANSWER -Diastolic "rumbling murmur" with
opening snap
systolic crescendo/decrescendo murmur - ANSWER -Aortic Stenosis or Hypertrophic
Cardiomyopathy (but Aortic Stenosis will be louder with squatting or leg raise)
Holosystolic Murmur that radiates to Axilla - ANSWER -Mitral Valve Insufficiency
Diastolic Decrescendo Murmur (austin flint murmur) - ANSWER -Aortic Insufficiency
Mitral Valve Prolapse and Hypertrophic Cardiomyopathy are the only two in which murmurs are
increased with...... - ANSWER -Valsalva or Standing (less blood to heart)
Most Common Cause of secondary HTN overall - ANSWER -Renal Artery Stenosis
AND ANSWERS Verified Solutions A
Bilateral Hilar Adenopathy - ANSWER -think Sarcoidosis!! (non caseasting granulomas,
interstitial lung disease, hypercalcemia and erythema nodosum)
Asbestosis: 1) location in lung 2) type of cancer risk 3) gross physical findings 4) histo findings
5) at risk population - ANSWER -*LOWER lobes
*mesothelioma & bronchogenic carcinoma
*pleural calcifications (plaques)
*asbestosis fiber=dumb bell
*shipyard workers, insulation, brake lining
Patient is a sand blaster/miner/glass or pottery worker...at risk for what lung disease? - ANSWER
-SILICOSIS-Fibrosis of UPPER lobes of lungs
What are patients with Silicosis at risk for? - ANSWER -Pulmonary TB (b/c of egg shell
calcifications of upper lung fields provide "nest" for TB)
COAL Miner's Disease - ANSWER -*IgA and IgG increased with decreased C3
* positive ANA
*small round nodular densities
*"CAPLAN SYNDROME"if with RA of lung
PULMONARY HYPERTENSION IS DEFINED AS: - ANSWER -PULMONARY ARTERY
PRESSURE >25MMHG OR >35MMHG DURING EXCERCISE (nml: 10-14mmHg)
What are results of Pulmonary Hypertension? - ANSWER -Atherosclerosis, intimal fibrosis of
pulmonary arteries
,Treatment for Pulmonary Hypertension? - ANSWER -1st: IV prostacyclins or other
VASODILATORS (adenosine, NO)
2nd: Calcium Channel Blocker
3rd: for Thromboprophylaxis: Warfarin
2ndary causes of Pulmonary Hypertension - ANSWER -1) COPD
2) Mitral Stenosis
3) Systemic Sclerosis (Scleroderma)
4) L-->R shunt (ASD/VSD)
5) Sleep Apnea or High altitude
6) Recurrent Thromboembolism
First step in Diagnosing Pulmonary Hypertension - ANSWER -Echo and Swan Ganz Catheter
(shows RVH and high PAP)
Besides ECHO and Swan Ganz Cath- Other diagnostic findings in Pulmonary Hypertension -
ANSWER -EKG-Rt axis deviation, evidence of RVH and RA enalrgement
Labs-polycythemia
Common respiratory conditions in HIV patients - ANSWER -1) CD4<200, Penuomocystic
Jiroveci
2) CD4<50 Mycobacterium Avium-intracellulare
3) CMV - intranuclear inclusion bodies
4) Aspergillosis fumigatus-pleuritic pain, hemoptysis, infiltrates on imaging
only 2 rx that are proven to reduce MORBIDITY and MORTALITY in COPD patients: -
ANSWER -1) O2 therapy (if o2 sat<88%, PaO2 is <55 or <60 w/ cor pulmonale)
2) Smoking Cessation
, Coal Minder Patient - ANSWER -SILICOSIS---patient should be tested for TB!!!
X-ray shows flattened diaphragm - ANSWER -COPD
Midsystolic Click and late systolic murmur indicative of.... - ANSWER -Mitral Valve Prolapse
Mitral Valve Stenosis is most commonly caused by... - ANSWER -Rheumatic Fever (secondary
to strep infection causing X rxn with valve)
Most common complications of Mitral valve stenosis - ANSWER -Atrial Fibrillation and
Pulmonary Edema
Clinical presentations of Mitral Stenosis - ANSWER -Diastolic "rumbling murmur" with
opening snap
systolic crescendo/decrescendo murmur - ANSWER -Aortic Stenosis or Hypertrophic
Cardiomyopathy (but Aortic Stenosis will be louder with squatting or leg raise)
Holosystolic Murmur that radiates to Axilla - ANSWER -Mitral Valve Insufficiency
Diastolic Decrescendo Murmur (austin flint murmur) - ANSWER -Aortic Insufficiency
Mitral Valve Prolapse and Hypertrophic Cardiomyopathy are the only two in which murmurs are
increased with...... - ANSWER -Valsalva or Standing (less blood to heart)
Most Common Cause of secondary HTN overall - ANSWER -Renal Artery Stenosis
