Internal Medicine COMAT Key Phrases | High-Yield Review & Practice Questions
Abdominal Distention W/Ascites differentials
-CIRRHOSIS/portal HTN, heart failure
-metastasis, infection, peritonitis
physical exam findings
-LAD (esp. supraclavicular, virchow's node): metastatic abdominal malignancy
-elevated JVP: heart failure
-spider angiomas, palmar erythema, caput medusae, gynecomastia: liver
disease
diagnostic testing
-abdominal US FIRST, CT if needed
-labs: LFTs, albumin, INR, CBC, amylase/lipase
-paracentesis
SAAG
-high SAAG = portal HTN: cirrhosis, cardiac ascites, hepatic vein thrombosis
(budd chiari), sinusoidal obstruction, liver metastasis
-low SAAG = TB, pancreatic ascites, nephrotic syndrome, biliary leak
methemoglobinemia due to exposure of oxidizing substances (dapsone, topical anesthetics)
symptoms
-cyanosis
-LOW pulse ox, but NORMAL PaO2 (so supplemental O2 will NOT alleviate
cyanosis)
-dark chocolate blood
treatment: methylene blue
Acute Delirium Post-Op most common post-op complication in older adults
-may persist for months
causes: drugs, infection, electrolyte imbalance, immobility
signs: confusion, disorientation, persistent sleepiness, hallucinations, agitation
treatment: haloperidol
guillain-barre syndrome (GBS) acute demyelination of peripheral nerves
causes
-infections: C. jejuni, M. pneumoniae, CMV, EBV, VZV
-trauma, surgery
signs (usually FOLLOWS infection)
-ASCENDING symmetric paralysis
-absent deep tendon reflexes
-tingling/paresthesias in feet --> trouble breathing --> choking/hard to swallow
-autonomic dysfunctions
management
-plasma exchange, Ig therapy
-monitor respiratory function (respiratory failure can occur without signs of
dyspnea)
ACUTE GOUTY ARTHRITIS inflammation and swelling in first metatarsophalangeal joint
diagnosis
-joint fluid test
-blood test (measure uric acid)
-US detects urate crystals/tophi
treatment
-NSAIDs
-steroids
-colchicine
, Internal Medicine COMAT Key Phrases | High-Yield Review & Practice Questions
Acute Hepatitis A transmitted via contaminated food/water
-rare in US, but suspect with travel hx
symptoms
-sudden nausea/vomiting
-abdominal pain (esp. upper right side)
-jaundice, hepatomegaly
-CLAY-COLORED bowel movements, dark urine
labs
-elevated AST/ALT, alk phos
-elevated bilirubin
-hepatitis A antibody
Acute Intermittent Porphyria symptoms "5 Ps"
-pain in abdomen
-peripheral neuropathy (muscle pain, tingling)
-pee is RED/BROWN
-psych symptoms (anxiety, delirium)
-precipitated by drugs (ex. barbiturates, OCPs, sulfa)
diagnosis: elevated PBG in urine
Acute Meningitis due to Streptococcus pneumoniae MOST COMMON cause of bacterial meningitis in adults
has pneumococcal vaccine
symptoms
-confusion, HA, stiff neck
-high fever, chills
-vomiting, cough
management
1) order/obtain blood culture
2) empirically start abx
3) non-contrast CT of head
Acute Mesenteric Ischemia lab abnormalities
-leukocytosis
-metabolic acidosis (decreased bicarb, elevated CO2)
-elevated D-dimer
-elevated LDH
diagnose via CT angiography
acquired hemophilia diagnosis
-ELEVATED: PTT
-NORMAL: PT, platelets, bleeding time
ACUTE PERICARDIAL TAMPONADE beck's triad
-hypotension
-JVD
-MUFFLED heart sounds
excessive fluid accumulates in pericardium, compresses the heart and restricts
filling
primary adrenal Insufficiency diagnosis
-ACTH stimulation test will show NO change (in SECONDARY insufficiency, you
expect an increase in cortisol and aldosterone levels)
symptoms
-extreme fatigue, weight loss, decreased appetite, hyponatremia, hyperkalemia
-hypotension, SALT craving, hypoglycemia
-SKIN HYPERPIGMENTATION (only in PRIMARY insufficiency)
Alcohol Toxicity heavy drinking causes thrombocytopenia
-directly toxic effect on platelet production, survival time, and function
-indirectly toxic by causing splenomegaly and folate deficiency
low platelet counts may predict alcohol withdrawal complications
, Internal Medicine COMAT Key Phrases | High-Yield Review & Practice Questions
Alport Syndrome damage to tiny blood vessels in kidneys --> eventual kidney failure (around age
40)
-hematuria
-proteinuria
-HTN
-peripheral edema (legs, ankle, feet, around eyes)
other symptoms
-HEARING LOSS (late childhood/early adolescence)
-vision issues
AMIODARONE LUNG ADRs mechanism: anti-arrhythmic (Ca channel blocker)
causes pulmonary diseases
-interstitial pneumonitis
-ARDS
-diffuse alveolar hemorrhage
-pulmonary nodules
patient presentation
"shortness of breath, fever, cough"
Amyloidosis deposition of insoluble protein
-all organs eventually thicken and lose function
symptoms
-hepatomegaly
-nephrotic syndrome, edema
-ENLARGED TONGUE
-numbness/tingling in hands, feet, wrist
-BRUISES EASILY, skin folds are PURPLE
Anaerobic Bacterial Pneumonia does pt have hx of periodontal disease??
agents
-klebsiella (RED, currant jelly sputum)
-bacteroides (FOUL-SMELLING sputum)
-fusobacterium (FOUL-SMELLING sputum)
general symptoms
-FEVER, chills
-coughing
-shortness of breath, chest pain
anal fissure signs
-severe pain with defecation (since the tear is distal to the dentate line)
-posterior anal canal poorly perfused
pain is due to ischemia and internal sphincter spasm
Anaphylaxis systemic allergic reaction that leads to airway obstruction and/or vascular
collapse
-mediated by IgE, activates mast cells and basophils
treatment
-IM epinephrine ASAP
-adjuncts: histamine antagonists, corticosteroids
ANCA C-ANCA diseases
-granulomatosis with polyangiitis (wegener's granulomatosis)
P-ANCA diseases
-microscopic polyangiitis
-glomerulonephritis
-eosinophilic granulomatosis with polyangiitis (CHURG-STRAUSS)
-Goodpasture syndrome
-SLE, RA, Sjogren's
if test is negative, it is unlikely the symptoms are due to an autoimmune vasculitis
in IBD, a positive ANCA = ulcerative colitis
, Internal Medicine COMAT Key Phrases | High-Yield Review & Practice Questions
Anemia of Chronic Disease affects people who have autoimmune diseases, cancer, CKD
symptoms
-fatigue, weakness, dizzy
-pale skin
-sweating/diaphoretic
-palpitations
-HA
signs
-NORMAL ferritin
-LOW TIBC
-low blood Fe level
**differentiate from Fe deficiency anemia due to LOW ferritin + HIGH TIBC
Angina Pectoris symptoms
-pressing, squeezing pain (may spread to arms, upper back, haw)
-fatigue, weakness, SOB
Angioedema causes
-allergic reaction
-meds: ACE inhibitors, ARBs, NSAIDs
-genetic: C1 esterase inhibitor deficiency
Ankylosing Spondylitis symptoms
-stiffness in lower back/butt (esp. in the MORNING)
-IMPROVES with exercise, WORSENS with rest
-may also have pain in hips, heels, soles of feet
Anterior Spinal Artery Occlusion AKA anterior cord syndrome
symptoms
-bilateral FLACCID quadriplegia
-LOSS of pain/temp
-INTACT proprioception/vibration
autonomic dysfunction
-hypotension
-bradycardia
-impaired temp regulation
anterior wall MI signs: chest pain, tightness, SOB, nausea, diaphoresis
-female or DM pts may only have nausea, anxiety, light-headedness
EKG
-ST elevations V1-V4
-reciprocal ST depressions leads II, III, aVF
occlusion of LAD
Antiphospholipid Antibody Syndrome the body mistakenly creates antibodies that make you hypercoagulable
symptoms
-DVT (pain, swelling, redness in legs), could cause PE
-REPEATED MISCARRIAGES
-TIA/stroke
-rash
Aortic Regurgitation (Insufficiency) symptoms
-uvular pulsation, hammer pulse
-SOB on exertion, when lying flat, or at night
-palpitations, angina
-swelling of legs/feet
signs
-early diastolic murmur at left lower sternal border
-collapsing pulse, wide pulse pressure
-laterally displaced apex beat
-carotid pulsations (head nodding with each heartbeat)
Abdominal Distention W/Ascites differentials
-CIRRHOSIS/portal HTN, heart failure
-metastasis, infection, peritonitis
physical exam findings
-LAD (esp. supraclavicular, virchow's node): metastatic abdominal malignancy
-elevated JVP: heart failure
-spider angiomas, palmar erythema, caput medusae, gynecomastia: liver
disease
diagnostic testing
-abdominal US FIRST, CT if needed
-labs: LFTs, albumin, INR, CBC, amylase/lipase
-paracentesis
SAAG
-high SAAG = portal HTN: cirrhosis, cardiac ascites, hepatic vein thrombosis
(budd chiari), sinusoidal obstruction, liver metastasis
-low SAAG = TB, pancreatic ascites, nephrotic syndrome, biliary leak
methemoglobinemia due to exposure of oxidizing substances (dapsone, topical anesthetics)
symptoms
-cyanosis
-LOW pulse ox, but NORMAL PaO2 (so supplemental O2 will NOT alleviate
cyanosis)
-dark chocolate blood
treatment: methylene blue
Acute Delirium Post-Op most common post-op complication in older adults
-may persist for months
causes: drugs, infection, electrolyte imbalance, immobility
signs: confusion, disorientation, persistent sleepiness, hallucinations, agitation
treatment: haloperidol
guillain-barre syndrome (GBS) acute demyelination of peripheral nerves
causes
-infections: C. jejuni, M. pneumoniae, CMV, EBV, VZV
-trauma, surgery
signs (usually FOLLOWS infection)
-ASCENDING symmetric paralysis
-absent deep tendon reflexes
-tingling/paresthesias in feet --> trouble breathing --> choking/hard to swallow
-autonomic dysfunctions
management
-plasma exchange, Ig therapy
-monitor respiratory function (respiratory failure can occur without signs of
dyspnea)
ACUTE GOUTY ARTHRITIS inflammation and swelling in first metatarsophalangeal joint
diagnosis
-joint fluid test
-blood test (measure uric acid)
-US detects urate crystals/tophi
treatment
-NSAIDs
-steroids
-colchicine
, Internal Medicine COMAT Key Phrases | High-Yield Review & Practice Questions
Acute Hepatitis A transmitted via contaminated food/water
-rare in US, but suspect with travel hx
symptoms
-sudden nausea/vomiting
-abdominal pain (esp. upper right side)
-jaundice, hepatomegaly
-CLAY-COLORED bowel movements, dark urine
labs
-elevated AST/ALT, alk phos
-elevated bilirubin
-hepatitis A antibody
Acute Intermittent Porphyria symptoms "5 Ps"
-pain in abdomen
-peripheral neuropathy (muscle pain, tingling)
-pee is RED/BROWN
-psych symptoms (anxiety, delirium)
-precipitated by drugs (ex. barbiturates, OCPs, sulfa)
diagnosis: elevated PBG in urine
Acute Meningitis due to Streptococcus pneumoniae MOST COMMON cause of bacterial meningitis in adults
has pneumococcal vaccine
symptoms
-confusion, HA, stiff neck
-high fever, chills
-vomiting, cough
management
1) order/obtain blood culture
2) empirically start abx
3) non-contrast CT of head
Acute Mesenteric Ischemia lab abnormalities
-leukocytosis
-metabolic acidosis (decreased bicarb, elevated CO2)
-elevated D-dimer
-elevated LDH
diagnose via CT angiography
acquired hemophilia diagnosis
-ELEVATED: PTT
-NORMAL: PT, platelets, bleeding time
ACUTE PERICARDIAL TAMPONADE beck's triad
-hypotension
-JVD
-MUFFLED heart sounds
excessive fluid accumulates in pericardium, compresses the heart and restricts
filling
primary adrenal Insufficiency diagnosis
-ACTH stimulation test will show NO change (in SECONDARY insufficiency, you
expect an increase in cortisol and aldosterone levels)
symptoms
-extreme fatigue, weight loss, decreased appetite, hyponatremia, hyperkalemia
-hypotension, SALT craving, hypoglycemia
-SKIN HYPERPIGMENTATION (only in PRIMARY insufficiency)
Alcohol Toxicity heavy drinking causes thrombocytopenia
-directly toxic effect on platelet production, survival time, and function
-indirectly toxic by causing splenomegaly and folate deficiency
low platelet counts may predict alcohol withdrawal complications
, Internal Medicine COMAT Key Phrases | High-Yield Review & Practice Questions
Alport Syndrome damage to tiny blood vessels in kidneys --> eventual kidney failure (around age
40)
-hematuria
-proteinuria
-HTN
-peripheral edema (legs, ankle, feet, around eyes)
other symptoms
-HEARING LOSS (late childhood/early adolescence)
-vision issues
AMIODARONE LUNG ADRs mechanism: anti-arrhythmic (Ca channel blocker)
causes pulmonary diseases
-interstitial pneumonitis
-ARDS
-diffuse alveolar hemorrhage
-pulmonary nodules
patient presentation
"shortness of breath, fever, cough"
Amyloidosis deposition of insoluble protein
-all organs eventually thicken and lose function
symptoms
-hepatomegaly
-nephrotic syndrome, edema
-ENLARGED TONGUE
-numbness/tingling in hands, feet, wrist
-BRUISES EASILY, skin folds are PURPLE
Anaerobic Bacterial Pneumonia does pt have hx of periodontal disease??
agents
-klebsiella (RED, currant jelly sputum)
-bacteroides (FOUL-SMELLING sputum)
-fusobacterium (FOUL-SMELLING sputum)
general symptoms
-FEVER, chills
-coughing
-shortness of breath, chest pain
anal fissure signs
-severe pain with defecation (since the tear is distal to the dentate line)
-posterior anal canal poorly perfused
pain is due to ischemia and internal sphincter spasm
Anaphylaxis systemic allergic reaction that leads to airway obstruction and/or vascular
collapse
-mediated by IgE, activates mast cells and basophils
treatment
-IM epinephrine ASAP
-adjuncts: histamine antagonists, corticosteroids
ANCA C-ANCA diseases
-granulomatosis with polyangiitis (wegener's granulomatosis)
P-ANCA diseases
-microscopic polyangiitis
-glomerulonephritis
-eosinophilic granulomatosis with polyangiitis (CHURG-STRAUSS)
-Goodpasture syndrome
-SLE, RA, Sjogren's
if test is negative, it is unlikely the symptoms are due to an autoimmune vasculitis
in IBD, a positive ANCA = ulcerative colitis
, Internal Medicine COMAT Key Phrases | High-Yield Review & Practice Questions
Anemia of Chronic Disease affects people who have autoimmune diseases, cancer, CKD
symptoms
-fatigue, weakness, dizzy
-pale skin
-sweating/diaphoretic
-palpitations
-HA
signs
-NORMAL ferritin
-LOW TIBC
-low blood Fe level
**differentiate from Fe deficiency anemia due to LOW ferritin + HIGH TIBC
Angina Pectoris symptoms
-pressing, squeezing pain (may spread to arms, upper back, haw)
-fatigue, weakness, SOB
Angioedema causes
-allergic reaction
-meds: ACE inhibitors, ARBs, NSAIDs
-genetic: C1 esterase inhibitor deficiency
Ankylosing Spondylitis symptoms
-stiffness in lower back/butt (esp. in the MORNING)
-IMPROVES with exercise, WORSENS with rest
-may also have pain in hips, heels, soles of feet
Anterior Spinal Artery Occlusion AKA anterior cord syndrome
symptoms
-bilateral FLACCID quadriplegia
-LOSS of pain/temp
-INTACT proprioception/vibration
autonomic dysfunction
-hypotension
-bradycardia
-impaired temp regulation
anterior wall MI signs: chest pain, tightness, SOB, nausea, diaphoresis
-female or DM pts may only have nausea, anxiety, light-headedness
EKG
-ST elevations V1-V4
-reciprocal ST depressions leads II, III, aVF
occlusion of LAD
Antiphospholipid Antibody Syndrome the body mistakenly creates antibodies that make you hypercoagulable
symptoms
-DVT (pain, swelling, redness in legs), could cause PE
-REPEATED MISCARRIAGES
-TIA/stroke
-rash
Aortic Regurgitation (Insufficiency) symptoms
-uvular pulsation, hammer pulse
-SOB on exertion, when lying flat, or at night
-palpitations, angina
-swelling of legs/feet
signs
-early diastolic murmur at left lower sternal border
-collapsing pulse, wide pulse pressure
-laterally displaced apex beat
-carotid pulsations (head nodding with each heartbeat)
