INTERNAL MED- EOR Questions ,
Answers and Important Explanations
Guaranteed success
Treatment for SIADH - ANSWER -Fluid restriction
Heinz bodies - ANSWER -G6PD deficiency
X-linked recessive
Low PTH = low or high Ca - ANSWER -LOW Calcium
Tetany
Chvostek sign (contraction of facial muscles after tapping facial nerve)
Trousseau sign (induction of carpal pedal spasm)
Paresthesias (fingertips and perioral)
Prolonged QT interval - ANSWER -Hypocalcemia
Hypoparathyroidism
PS: high phosphorous
Paresthesias, muscle cramping or spasms, bowel or bladder dysfunction, ataxia, tremor, cognitive
changes, facial weakness, and facial muscle twitching - ANSWER -Multiple sclerosis
CSF will show ↑ IgG protein, WBC pleocytosis - ANSWER -Multiple sclerosis
,Dry eyes (Xerophthalmia) and dry mouth (Xerostomia) - ANSWER -Sjogrens
Labs for Sjogrens - ANSWER -Labs will show SSA (anti-Ro) or SSB (anti-La)
Dx: + Schirmer test
An 80-year-old woman with a 36-pack-year history of smoking tobacco presents with a chief
complaint of increasing dyspnea on exertion over the past six months. Physical exam reveals
clubbed digits and bilateral lower lung crackles. Computed tomography shows honeycombing of
the lung parenchyma. What is the most likely diagnosis? - ANSWER -Idiopathic pulmonary
fibrosis
HIV CD4 related illnesses - ANSWER -< 250: Esophageal candidiasis
< 200: PCP pneumonia
< 100: Cerebral toxoplasmosis, Cryptococcosis
< 50: Mycobacterium avian complex- ppx: Azithro
A 24-year-old woman presents to the Emergency Department with fever and shortness-of-breath
for the last 48 hours. Her past medical history is significant for recent IV drug abuse. On physical
exam, you auscultate a pansystolic ejection murmur best heard at the left lower sternal border. You
also note nontender macular lesions on the palms of her hands and soles of her feet. Laboratory
analysis is significant for a white blood cell count of 20,000/mcL, erythrocyte sedimentation rate
of 67 mm/hour, and C-reactive protein of 6.5 mg/L. Which imaging modality would be most
appropriate to confirm your diagnosis? - ANSWER -TTE
Infective endocarditis is an infection of the endocardium of the heart. In general, this infection
occurs at one or more of the valves of the heart. Significant risk factors include advanced age, male
gender, injection drug abuse, poor dentition, and prosthetic heart valves. In the setting of injection
drug abuse, the tricuspid valve is most commonly affected. Signs and symptoms include fever,
malaise, exercise intolerance and a new-onset heart murmur. Janeway lesions (nontender
erythematous macular lesions of the palms and soles), Osler nodes (tender lesions on the pads of
fingers and toes) and Roth spots (hemorrhagic retinal lesions) may also be found and are highly
suggestive of infectious endocarditis. Transthoracic echocardiography is the primary imaging
,modality indicated for evaluation of infective endocarditis. Transthoracic echocardiography is
preferred due to the non-invasive approach combined with high sensitivity and specificity. Many
patients may also require transesophageal echocardiography to rule out complications such as
abscess, leaflet perforation, and pseudoaneurysm. Due to its invasive approach, however, it is not
generally recommended as first-line imaging.
Diagnosis is made by 24-hour excretion of 5-hydroxyindoleacetic acid - ANSWER -Carcinoid
Syndrome
Skin flushing
Diarrhea
Blanching maculopapular rash around the wrists and ankles and has a centripetal spread toward
the body. - ANSWER -Rocky Mountain spotted fever
Rickettsia rickettsii
Tx: ALWAYS doxy
ANCA negative
HIGH ESR
renal or mesenteric angiography: microaneurysms with abrupt cut-off of small arteries
PE: HTN, nothing on lungs, inflammation of nerve - ANSWER -Polyarteritis nodosa
Management: corticosteroids
Ship builder with pleural plaques, pleural thickening, interstitial fibrosis - ANSWER -Asbestosis
, CT= honeycomb lung, primarily lower lobes - ANSWER -Asbestosis
Older M with rectal bleeding with hemorrhoid. Colonoscopy? - ANSWER -Yes!
Guy with high H&H. PE finding: - ANSWER -splenomegaly
Nephrotic syndrome PE - ANSWER -P: Proteinuria
A: low Albumin
L: high Lipids
E: Edema
UA= fat bodies (maltese cross shaped) - ANSWER -Nephrotic syndrome
Kid with gum bleeding after dental surgery who has vWb, what do you give? - ANSWER -
Desmopressin
vWF
Factor VIII concentrate
18 yo M with testicular pain, swelling, redness. Tx? - ANSWER -Surgery!
HIV pt with positive PPD but negative xray. Tx? - ANSWER -INH 300 PO QD +
Pyridoxine 25mg PO QD x 12 months
Rash with central clearing - ANSWER -Lyme Dz
Erythema migrans
Bug for Lyme - ANSWER -Borrelia burgdorferi
Answers and Important Explanations
Guaranteed success
Treatment for SIADH - ANSWER -Fluid restriction
Heinz bodies - ANSWER -G6PD deficiency
X-linked recessive
Low PTH = low or high Ca - ANSWER -LOW Calcium
Tetany
Chvostek sign (contraction of facial muscles after tapping facial nerve)
Trousseau sign (induction of carpal pedal spasm)
Paresthesias (fingertips and perioral)
Prolonged QT interval - ANSWER -Hypocalcemia
Hypoparathyroidism
PS: high phosphorous
Paresthesias, muscle cramping or spasms, bowel or bladder dysfunction, ataxia, tremor, cognitive
changes, facial weakness, and facial muscle twitching - ANSWER -Multiple sclerosis
CSF will show ↑ IgG protein, WBC pleocytosis - ANSWER -Multiple sclerosis
,Dry eyes (Xerophthalmia) and dry mouth (Xerostomia) - ANSWER -Sjogrens
Labs for Sjogrens - ANSWER -Labs will show SSA (anti-Ro) or SSB (anti-La)
Dx: + Schirmer test
An 80-year-old woman with a 36-pack-year history of smoking tobacco presents with a chief
complaint of increasing dyspnea on exertion over the past six months. Physical exam reveals
clubbed digits and bilateral lower lung crackles. Computed tomography shows honeycombing of
the lung parenchyma. What is the most likely diagnosis? - ANSWER -Idiopathic pulmonary
fibrosis
HIV CD4 related illnesses - ANSWER -< 250: Esophageal candidiasis
< 200: PCP pneumonia
< 100: Cerebral toxoplasmosis, Cryptococcosis
< 50: Mycobacterium avian complex- ppx: Azithro
A 24-year-old woman presents to the Emergency Department with fever and shortness-of-breath
for the last 48 hours. Her past medical history is significant for recent IV drug abuse. On physical
exam, you auscultate a pansystolic ejection murmur best heard at the left lower sternal border. You
also note nontender macular lesions on the palms of her hands and soles of her feet. Laboratory
analysis is significant for a white blood cell count of 20,000/mcL, erythrocyte sedimentation rate
of 67 mm/hour, and C-reactive protein of 6.5 mg/L. Which imaging modality would be most
appropriate to confirm your diagnosis? - ANSWER -TTE
Infective endocarditis is an infection of the endocardium of the heart. In general, this infection
occurs at one or more of the valves of the heart. Significant risk factors include advanced age, male
gender, injection drug abuse, poor dentition, and prosthetic heart valves. In the setting of injection
drug abuse, the tricuspid valve is most commonly affected. Signs and symptoms include fever,
malaise, exercise intolerance and a new-onset heart murmur. Janeway lesions (nontender
erythematous macular lesions of the palms and soles), Osler nodes (tender lesions on the pads of
fingers and toes) and Roth spots (hemorrhagic retinal lesions) may also be found and are highly
suggestive of infectious endocarditis. Transthoracic echocardiography is the primary imaging
,modality indicated for evaluation of infective endocarditis. Transthoracic echocardiography is
preferred due to the non-invasive approach combined with high sensitivity and specificity. Many
patients may also require transesophageal echocardiography to rule out complications such as
abscess, leaflet perforation, and pseudoaneurysm. Due to its invasive approach, however, it is not
generally recommended as first-line imaging.
Diagnosis is made by 24-hour excretion of 5-hydroxyindoleacetic acid - ANSWER -Carcinoid
Syndrome
Skin flushing
Diarrhea
Blanching maculopapular rash around the wrists and ankles and has a centripetal spread toward
the body. - ANSWER -Rocky Mountain spotted fever
Rickettsia rickettsii
Tx: ALWAYS doxy
ANCA negative
HIGH ESR
renal or mesenteric angiography: microaneurysms with abrupt cut-off of small arteries
PE: HTN, nothing on lungs, inflammation of nerve - ANSWER -Polyarteritis nodosa
Management: corticosteroids
Ship builder with pleural plaques, pleural thickening, interstitial fibrosis - ANSWER -Asbestosis
, CT= honeycomb lung, primarily lower lobes - ANSWER -Asbestosis
Older M with rectal bleeding with hemorrhoid. Colonoscopy? - ANSWER -Yes!
Guy with high H&H. PE finding: - ANSWER -splenomegaly
Nephrotic syndrome PE - ANSWER -P: Proteinuria
A: low Albumin
L: high Lipids
E: Edema
UA= fat bodies (maltese cross shaped) - ANSWER -Nephrotic syndrome
Kid with gum bleeding after dental surgery who has vWb, what do you give? - ANSWER -
Desmopressin
vWF
Factor VIII concentrate
18 yo M with testicular pain, swelling, redness. Tx? - ANSWER -Surgery!
HIV pt with positive PPD but negative xray. Tx? - ANSWER -INH 300 PO QD +
Pyridoxine 25mg PO QD x 12 months
Rash with central clearing - ANSWER -Lyme Dz
Erythema migrans
Bug for Lyme - ANSWER -Borrelia burgdorferi
