INTERNAL MEDICINE COMAT REVIEW
EXAM WITH CORRECT ACTUAL
QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS LATEST ALREADY
GRADED A+
Bloody lumbar puncture is associated with...
Subarachnoid hemorrhage & herpes encephalopathy.
Common associations w/Waterhouse-Friderichsen
syndrome (hemorrhage of adrenal glands & septic shock
from N meningitidis)
DIC & petechial rash.
Common presentation of acute lymphoblastic leukemia
(ALL)
Presents in a younger child (2-5 years old) with fever (due to
neutropenia), pallor & fatigue due to anemia, & petechiae
(due to thrombocytopenia).
What's a major differentiating factor between TTP/HUS and
DIC?
,DIC is associated with an increase in both PT and PTT (not
TTP/HUS), and bleeding usually occurs at venipuncture sites.
What are some differentiating factors btwn TTP and HUS
HUS is often associated with a prodromal bloody diarrhea
TTP often is associated with neurological deficits
Characteristics common to both TTP and HUS
Fever, anemia, & acute renal failure.
Both can present with elevated LDH, indirect bilirubin, and
schistocytes on peripheral smear (consistent with MAHA-
microangiopathic hemolytic anemia).
Hallmark metabolic disturbance of refeeding syndrome
Hypophosphatemia
Best 1st test when a patient comes in w/chest pain
EKG
Changes in EKG suggesting a STEMI
ST elevation 2mm or new LBBB
Anterior infarct
LAD
Leads V1-4
Lateral infarct
,Circumflex artery
Leads I, aVL, V4-6
Inferior infarct
Right coronary artery
Leads II, III, & aVF
Right ventricular infarct
Right coronary artery
Leads--> V4 on R-sided EKG= 100% specific
Symptoms of right ventricular infarct
Hypotension, tachycardia, clear lungs, JVD, and NO pulsus
paradoxus...
DON'T give nitro!! Also avoid Morphine and Diuretics
Treatment of right ventricular infarct
Vigorous fluid resuscitation.
Next best test in chest pain patient after EKG
Cardiac enzymes... (Myoglobin, CKMB, troponin I)
if elevated--> NSTEMI!! (check enzymes q 8hrs X3)
First cardiac enzyme to elevate in an NSTEMI
myoglobin (peaks in 2 hrs, normal by 24 hrs). **that's why
this is the best biomarker to use to see if there's a repeat
STEMI
Which cardiac enzyme lasts the longest in blood strem
, Troponin I
Treatment of a STEMI
emergency reperfusion- go to cath lab or thrombolytics if no
contraindications
Treatment of NSTEMI
MONA-B
Morphine
Oxygen
Nitrates
Aspirin/clopidogrel
B-blocker
Also: do CORONARY ANGIOGRAPHY within 48 hrs to
determine need for intervention
Standard treatment for NSTEMI
PCI w/stenting.
Indications for CABG
L main disease
3 vessel disease (or 2 vessel disease + DM)
>70% occlusion
Pain despite maximum medical treatment
Post-infarction angina
Discharge Medications after heart attack
Aspirin (+ clopidogrel for 9-12 months if stent is placed)
EXAM WITH CORRECT ACTUAL
QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS LATEST ALREADY
GRADED A+
Bloody lumbar puncture is associated with...
Subarachnoid hemorrhage & herpes encephalopathy.
Common associations w/Waterhouse-Friderichsen
syndrome (hemorrhage of adrenal glands & septic shock
from N meningitidis)
DIC & petechial rash.
Common presentation of acute lymphoblastic leukemia
(ALL)
Presents in a younger child (2-5 years old) with fever (due to
neutropenia), pallor & fatigue due to anemia, & petechiae
(due to thrombocytopenia).
What's a major differentiating factor between TTP/HUS and
DIC?
,DIC is associated with an increase in both PT and PTT (not
TTP/HUS), and bleeding usually occurs at venipuncture sites.
What are some differentiating factors btwn TTP and HUS
HUS is often associated with a prodromal bloody diarrhea
TTP often is associated with neurological deficits
Characteristics common to both TTP and HUS
Fever, anemia, & acute renal failure.
Both can present with elevated LDH, indirect bilirubin, and
schistocytes on peripheral smear (consistent with MAHA-
microangiopathic hemolytic anemia).
Hallmark metabolic disturbance of refeeding syndrome
Hypophosphatemia
Best 1st test when a patient comes in w/chest pain
EKG
Changes in EKG suggesting a STEMI
ST elevation 2mm or new LBBB
Anterior infarct
LAD
Leads V1-4
Lateral infarct
,Circumflex artery
Leads I, aVL, V4-6
Inferior infarct
Right coronary artery
Leads II, III, & aVF
Right ventricular infarct
Right coronary artery
Leads--> V4 on R-sided EKG= 100% specific
Symptoms of right ventricular infarct
Hypotension, tachycardia, clear lungs, JVD, and NO pulsus
paradoxus...
DON'T give nitro!! Also avoid Morphine and Diuretics
Treatment of right ventricular infarct
Vigorous fluid resuscitation.
Next best test in chest pain patient after EKG
Cardiac enzymes... (Myoglobin, CKMB, troponin I)
if elevated--> NSTEMI!! (check enzymes q 8hrs X3)
First cardiac enzyme to elevate in an NSTEMI
myoglobin (peaks in 2 hrs, normal by 24 hrs). **that's why
this is the best biomarker to use to see if there's a repeat
STEMI
Which cardiac enzyme lasts the longest in blood strem
, Troponin I
Treatment of a STEMI
emergency reperfusion- go to cath lab or thrombolytics if no
contraindications
Treatment of NSTEMI
MONA-B
Morphine
Oxygen
Nitrates
Aspirin/clopidogrel
B-blocker
Also: do CORONARY ANGIOGRAPHY within 48 hrs to
determine need for intervention
Standard treatment for NSTEMI
PCI w/stenting.
Indications for CABG
L main disease
3 vessel disease (or 2 vessel disease + DM)
>70% occlusion
Pain despite maximum medical treatment
Post-infarction angina
Discharge Medications after heart attack
Aspirin (+ clopidogrel for 9-12 months if stent is placed)
