INTERNAL MEDICINE COMAT
REVIEW QUESTIONS AND
ANSWERS (LATEST)
What should you consider in a patient with diarrhea accompanied by
flushing, tachycardia/hypotension - ANSWERS-Carcinoid syndrome.
What other problem can carcinoid syndrome cause? - ANSWERS-
Niacin deficiency (secondary to using all the tryptohphan to make
5HT)....
Dementia, Dermatitis, Diarrhea.
What's the presentation (& translocation) of CML? - ANSWERS-Pt
presentation= fatigue, night sweats, fever, splenomegaly, & elevated
WBCs.
CML- 9:22 translocation--> tyrosine kinase.
Treatment is with imantinib (gleevec), which inhibitrs tyrosine kinase
Dizziness, headache, hearing/vision problems, and monoclonal IgM
M-spike - ANSWERS-Waldenstrom macroglobulinemia.
,No symptoms but immunoglobulin spike found on routine exam? -
ANSWERS-MGUS (Monoclonal gammopathy of undetermined
significance)
how do you treat ventricular tachycardia? - ANSWERS-If patient is
unstable (unconscious, hypotensive etc): shock them.
If patient is stable: use medical treatment--> lidocaine or amiodarone.
**Treatment of Wolf-Parkinson-Whitte** - ANSWERS-
Procainamide!!
DON'T give (contraindicated): anything that slows AV conduction,
including B blockers, digoxin, CCB's that affect AV node (diltiazam
and verapamil)...anytime we slow AV nodal conduction we provide
more opportunity to send the extra signals through the extra pathways.
Diagnosis of Diabetes Mellitus - ANSWERS-o Fasting plasma
glucose >126
o Random plasma glucose >200 w/classic symptoms of diabetes
(polyuria, polydipsia)
o Hemoglobin A1C >6.5% (avg glucose levels over ~90-120
days...life of RBC)
o 2-hour plasma glucose >200 mg/dL after 75 gram oral glucose
tolerance test.
,Why can nephrotic syndrome predispose to an unprovoked thrombus?
- ANSWERS-Proteins are lost in the urine in nephrotic
syndrome...preferentially pee out ATIII, and Protein C & S, putting
the patient at risk for Renal Vein Thrombosis
ECG leads representing anterior wall - ANSWERS-V1-4 (LAD)
ECG leads representing the inferior portion of the heart - ANSWERS-
II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall - ANSWERS-I,
AVL, V5, & V6
When should you consider immediate diagnostic coronary
angiography? - ANSWERS-order immediate diagnostic coronary
angiography for a STEMI or new-onset Left BBB
Another name for angioplasty... - ANSWERS-Primary
In an acute inferior wall myocardial infarction, occlusion of which
coronary artery is usually implicated? - ANSWERS-Right coronary
artery
Difference in sounds between COPD and pulmonary
edema/interstitial lung disease. - ANSWERS-Wheezing or rhonchi=
more suggestive of COPD
, Crackles= more suggestive of pulmonary edema or interstitial lung
disease.
Most common cause of an S3 heart sound - ANSWERS-CHF
What are S3 heart sounds - ANSWERS-S3 results from increased
atrial pressure leading to increased flow rates, as seen in congestive
heart failure, which is the most common cause of an S3 heart sound.
causes of a mid-systolic non-radiating murmur - ANSWERS-High
output states (anemia, fever, thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? - ANSWERS-It's an early
DIASTOLIC murmur heard in the 2nd LEFT-upper sternal border.
Indications for ordering an echocardiogram - ANSWERS-1. Patient is
symptomatic w/murmur.
REVIEW QUESTIONS AND
ANSWERS (LATEST)
What should you consider in a patient with diarrhea accompanied by
flushing, tachycardia/hypotension - ANSWERS-Carcinoid syndrome.
What other problem can carcinoid syndrome cause? - ANSWERS-
Niacin deficiency (secondary to using all the tryptohphan to make
5HT)....
Dementia, Dermatitis, Diarrhea.
What's the presentation (& translocation) of CML? - ANSWERS-Pt
presentation= fatigue, night sweats, fever, splenomegaly, & elevated
WBCs.
CML- 9:22 translocation--> tyrosine kinase.
Treatment is with imantinib (gleevec), which inhibitrs tyrosine kinase
Dizziness, headache, hearing/vision problems, and monoclonal IgM
M-spike - ANSWERS-Waldenstrom macroglobulinemia.
,No symptoms but immunoglobulin spike found on routine exam? -
ANSWERS-MGUS (Monoclonal gammopathy of undetermined
significance)
how do you treat ventricular tachycardia? - ANSWERS-If patient is
unstable (unconscious, hypotensive etc): shock them.
If patient is stable: use medical treatment--> lidocaine or amiodarone.
**Treatment of Wolf-Parkinson-Whitte** - ANSWERS-
Procainamide!!
DON'T give (contraindicated): anything that slows AV conduction,
including B blockers, digoxin, CCB's that affect AV node (diltiazam
and verapamil)...anytime we slow AV nodal conduction we provide
more opportunity to send the extra signals through the extra pathways.
Diagnosis of Diabetes Mellitus - ANSWERS-o Fasting plasma
glucose >126
o Random plasma glucose >200 w/classic symptoms of diabetes
(polyuria, polydipsia)
o Hemoglobin A1C >6.5% (avg glucose levels over ~90-120
days...life of RBC)
o 2-hour plasma glucose >200 mg/dL after 75 gram oral glucose
tolerance test.
,Why can nephrotic syndrome predispose to an unprovoked thrombus?
- ANSWERS-Proteins are lost in the urine in nephrotic
syndrome...preferentially pee out ATIII, and Protein C & S, putting
the patient at risk for Renal Vein Thrombosis
ECG leads representing anterior wall - ANSWERS-V1-4 (LAD)
ECG leads representing the inferior portion of the heart - ANSWERS-
II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall - ANSWERS-I,
AVL, V5, & V6
When should you consider immediate diagnostic coronary
angiography? - ANSWERS-order immediate diagnostic coronary
angiography for a STEMI or new-onset Left BBB
Another name for angioplasty... - ANSWERS-Primary
In an acute inferior wall myocardial infarction, occlusion of which
coronary artery is usually implicated? - ANSWERS-Right coronary
artery
Difference in sounds between COPD and pulmonary
edema/interstitial lung disease. - ANSWERS-Wheezing or rhonchi=
more suggestive of COPD
, Crackles= more suggestive of pulmonary edema or interstitial lung
disease.
Most common cause of an S3 heart sound - ANSWERS-CHF
What are S3 heart sounds - ANSWERS-S3 results from increased
atrial pressure leading to increased flow rates, as seen in congestive
heart failure, which is the most common cause of an S3 heart sound.
causes of a mid-systolic non-radiating murmur - ANSWERS-High
output states (anemia, fever, thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? - ANSWERS-It's an early
DIASTOLIC murmur heard in the 2nd LEFT-upper sternal border.
Indications for ordering an echocardiogram - ANSWERS-1. Patient is
symptomatic w/murmur.
