INTERNAL MED- EOR QUESTIONS WITH ANSWERS
Treatment for SIADH - -Fluid restriction history of smoking tobacco presents with a chief
complaint of increasing dyspnea on exertion over
the past six months. Physical exam reveals
Heinz bodies - -G6PD deficiency clubbed digits and bilateral lower lung crackles.
Computed tomography shows honeycombing of
X-linked recessive the lung parenchyma. What is the most likely
diagnosis? - -Idiopathic pulmonary fibrosis
Low PTH = low or high Ca - -LOW Calcium
HIV CD4 related illnesses - -< 250:
Esophageal candidiasis
Tetany < 200: PCP pneumonia
Chvostek sign (contraction of facial muscles after < 100: Cerebral toxoplasmosis, Cryptococcosis
tapping facial nerve) < 50: Mycobacterium avian complex- ppx: Azithro
Trousseau sign (induction of carpal pedal spasm)
Paresthesias (fingertips and perioral)
Prolonged QT interval - -Hypocalcemia A 24-year-old woman presents to the Emergency
Department with fever and shortness-of-breath
Hypoparathyroidism for the last 48 hours. Her past medical history is
significant for recent IV drug abuse. On physical
PS: high phosphorous exam, you auscultate a pansystolic ejection
murmur best heard at the left lower sternal
border. You also note nontender macular lesions
Paresthesias, muscle cramping or spasms, on the palms of her hands and soles of her feet.
bowel or bladder dysfunction, ataxia, tremor, Laboratory analysis is significant for a white
cognitive changes, facial weakness, and facial blood cell count of 20,000/mcL, erythrocyte
sedimentation rate of 67 mm/hour, and C-
muscle twitching - -Multiple sclerosis
reactive protein of 6.5 mg/L. Which imaging
modality would be most appropriate to confirm
CSF will show ↑ IgG protein, WBC pleocytosis - your diagnosis? - -TTE
-Multiple sclerosis
Infective endocarditis is an infection of the
endocardium of the heart. In general, this
infection occurs at one or more of the valves of
Dry eyes (Xerophthalmia) and dry mouth
the heart. Significant risk factors include
(Xerostomia) - -Sjogrens advanced age, male gender, injection drug
abuse, poor dentition, and prosthetic heart
valves. In the setting of injection drug abuse, the
Labs for Sjogrens - -Labs will show SSA tricuspid valve is most commonly affected. Signs
(anti-Ro) or SSB (anti-La) and symptoms include fever, malaise, exercise
intolerance and a new-onset heart murmur.
Dx: + Schirmer test Janeway lesions (nontender erythematous
macular lesions of the palms and soles), Osler
nodes (tender lesions on the pads of fingers and
An 80-year-old woman with a 36-pack-year toes) and Roth spots (hemorrhagic retinal
,INTERNAL MED- EOR QUESTIONS WITH ANSWERS
lesions) may also be found and are highly thickening, interstitial fibrosis - -Asbestosis
suggestive of infectious endocarditis.
Transthoracic echocardiography is the primary
imaging modality indicated for evaluation of CT= honeycomb lung, primarily lower lobes -
infective endocarditis. Transthoracic -Asbestosis
echocardiography is preferred due to the non-
invasive approach combined with high sensitivity
and specificity. Many patients may also require Older M with rectal bleeding with hemorrhoid.
transesophageal echocardiography to rule out
Colonoscopy? - -Yes!
complications such as abscess, leaflet
perforation, and pseudoaneurysm. Due to its
invasive approach, however, it is not generally
recommended as first-line imaging. Guy with high H&H. PE finding: - -
splenomegaly
Diagnosis is made by 24-hour excretion of 5-
hydroxyindoleacetic acid - -Carcinoid Nephrotic syndrome PE - -P: Proteinuria
Syndrome A: low Albumin
L: high Lipids
Skin flushing E: Edema
Diarrhea
UA= fat bodies (maltese cross shaped) - -
Blanching maculopapular rash around the wrists Nephrotic syndrome
and ankles and has a centripetal spread toward
the body. - -Rocky Mountain spotted fever
Kid with gum bleeding after dental surgery who
Rickettsia rickettsii has vWb, what do you give? - -
Desmopressin
Tx: ALWAYS doxy vWF
Factor VIII concentrate
ANCA negative
HIGH ESR 18 yo M with testicular pain, swelling, redness.
renal or mesenteric angiography: Tx? - -Surgery!
microaneurysms with abrupt cut-off of small
arteries
HIV pt with positive PPD but negative xray. Tx? -
PE: HTN, nothing on lungs, inflammation of -INH 300 PO QD +
nerve - -Polyarteritis nodosa Pyridoxine 25mg PO QD x 12 months
Management: corticosteroids
Rash with central clearing - -Lyme Dz
Erythema migrans
Ship builder with pleural plaques, pleural
, INTERNAL MED- EOR QUESTIONS WITH ANSWERS
do you give them? - -Regular insulin
Bug for Lyme - -Borrelia burgdorferi
CXR of emphysema - -Hyperinflation: flat
Minimum amount of time on Coumadin for DVT - diaphragm, inc AP dm, dec vascular markings +/-
-1st episode w/ reversible or time-limiting BULLAE
RF (Trauma, surgery, OCP): 3 months
1st episode w/ idiopathic event= 6 months
Recurrent: 12 months, long term PE: hyperresonance to percussion, decreased
breath sounds, decreased fremitus, increased AP
diameter, pursed lip breathing - -
Surgical resection of ileum, what supplement do Emphysema
you need? - -B12
AP diameter= barrel chest
Pursed lip: pink puffer
Healthy pt with BP 148/95, labs = hypokalemia.
What is it? - -Primary Aldosteronism
(Conn's) LT tx for pt with persistent VTach - -
Amiodorone
Procainamide
LT treatment of WPW - -Amiodarone
Procainamide
Biopsy for Crohn's? - -Skip lesions
Transmural
What would you do for someone with Mobitz Cobblestone appearance
Type 1 Block - -Atropine
Cobblestone appearance on colonoscopy -
Pt comes with 30 sec LOC and confused -Crohn's
afterwards. What type of szr is this? - -
Tonic clonic
Barium flow through narrowed inflamed/scarred
area due to transmural strictures - -Crohn's
Masked facies: loss of facial expressions -
-Parkinson's Dz
IBD P-ANCA, ASCA - -P-ANCA: UC
ASCA: CROHN'S
Girl presents with a spot on her cheek that
itches, next day she is covered in rash with
pustule with erythematous base - - Skip lesions - -Crohn's colonoscopy
Varicella
Initial management for spinal stenosis - -
Pt presents with DKA to ED. What kind of insulin Lumbar epidural steroid injection of CTS
Treatment for SIADH - -Fluid restriction history of smoking tobacco presents with a chief
complaint of increasing dyspnea on exertion over
the past six months. Physical exam reveals
Heinz bodies - -G6PD deficiency clubbed digits and bilateral lower lung crackles.
Computed tomography shows honeycombing of
X-linked recessive the lung parenchyma. What is the most likely
diagnosis? - -Idiopathic pulmonary fibrosis
Low PTH = low or high Ca - -LOW Calcium
HIV CD4 related illnesses - -< 250:
Esophageal candidiasis
Tetany < 200: PCP pneumonia
Chvostek sign (contraction of facial muscles after < 100: Cerebral toxoplasmosis, Cryptococcosis
tapping facial nerve) < 50: Mycobacterium avian complex- ppx: Azithro
Trousseau sign (induction of carpal pedal spasm)
Paresthesias (fingertips and perioral)
Prolonged QT interval - -Hypocalcemia A 24-year-old woman presents to the Emergency
Department with fever and shortness-of-breath
Hypoparathyroidism for the last 48 hours. Her past medical history is
significant for recent IV drug abuse. On physical
PS: high phosphorous exam, you auscultate a pansystolic ejection
murmur best heard at the left lower sternal
border. You also note nontender macular lesions
Paresthesias, muscle cramping or spasms, on the palms of her hands and soles of her feet.
bowel or bladder dysfunction, ataxia, tremor, Laboratory analysis is significant for a white
cognitive changes, facial weakness, and facial blood cell count of 20,000/mcL, erythrocyte
sedimentation rate of 67 mm/hour, and C-
muscle twitching - -Multiple sclerosis
reactive protein of 6.5 mg/L. Which imaging
modality would be most appropriate to confirm
CSF will show ↑ IgG protein, WBC pleocytosis - your diagnosis? - -TTE
-Multiple sclerosis
Infective endocarditis is an infection of the
endocardium of the heart. In general, this
infection occurs at one or more of the valves of
Dry eyes (Xerophthalmia) and dry mouth
the heart. Significant risk factors include
(Xerostomia) - -Sjogrens advanced age, male gender, injection drug
abuse, poor dentition, and prosthetic heart
valves. In the setting of injection drug abuse, the
Labs for Sjogrens - -Labs will show SSA tricuspid valve is most commonly affected. Signs
(anti-Ro) or SSB (anti-La) and symptoms include fever, malaise, exercise
intolerance and a new-onset heart murmur.
Dx: + Schirmer test Janeway lesions (nontender erythematous
macular lesions of the palms and soles), Osler
nodes (tender lesions on the pads of fingers and
An 80-year-old woman with a 36-pack-year toes) and Roth spots (hemorrhagic retinal
,INTERNAL MED- EOR QUESTIONS WITH ANSWERS
lesions) may also be found and are highly thickening, interstitial fibrosis - -Asbestosis
suggestive of infectious endocarditis.
Transthoracic echocardiography is the primary
imaging modality indicated for evaluation of CT= honeycomb lung, primarily lower lobes -
infective endocarditis. Transthoracic -Asbestosis
echocardiography is preferred due to the non-
invasive approach combined with high sensitivity
and specificity. Many patients may also require Older M with rectal bleeding with hemorrhoid.
transesophageal echocardiography to rule out
Colonoscopy? - -Yes!
complications such as abscess, leaflet
perforation, and pseudoaneurysm. Due to its
invasive approach, however, it is not generally
recommended as first-line imaging. Guy with high H&H. PE finding: - -
splenomegaly
Diagnosis is made by 24-hour excretion of 5-
hydroxyindoleacetic acid - -Carcinoid Nephrotic syndrome PE - -P: Proteinuria
Syndrome A: low Albumin
L: high Lipids
Skin flushing E: Edema
Diarrhea
UA= fat bodies (maltese cross shaped) - -
Blanching maculopapular rash around the wrists Nephrotic syndrome
and ankles and has a centripetal spread toward
the body. - -Rocky Mountain spotted fever
Kid with gum bleeding after dental surgery who
Rickettsia rickettsii has vWb, what do you give? - -
Desmopressin
Tx: ALWAYS doxy vWF
Factor VIII concentrate
ANCA negative
HIGH ESR 18 yo M with testicular pain, swelling, redness.
renal or mesenteric angiography: Tx? - -Surgery!
microaneurysms with abrupt cut-off of small
arteries
HIV pt with positive PPD but negative xray. Tx? -
PE: HTN, nothing on lungs, inflammation of -INH 300 PO QD +
nerve - -Polyarteritis nodosa Pyridoxine 25mg PO QD x 12 months
Management: corticosteroids
Rash with central clearing - -Lyme Dz
Erythema migrans
Ship builder with pleural plaques, pleural
, INTERNAL MED- EOR QUESTIONS WITH ANSWERS
do you give them? - -Regular insulin
Bug for Lyme - -Borrelia burgdorferi
CXR of emphysema - -Hyperinflation: flat
Minimum amount of time on Coumadin for DVT - diaphragm, inc AP dm, dec vascular markings +/-
-1st episode w/ reversible or time-limiting BULLAE
RF (Trauma, surgery, OCP): 3 months
1st episode w/ idiopathic event= 6 months
Recurrent: 12 months, long term PE: hyperresonance to percussion, decreased
breath sounds, decreased fremitus, increased AP
diameter, pursed lip breathing - -
Surgical resection of ileum, what supplement do Emphysema
you need? - -B12
AP diameter= barrel chest
Pursed lip: pink puffer
Healthy pt with BP 148/95, labs = hypokalemia.
What is it? - -Primary Aldosteronism
(Conn's) LT tx for pt with persistent VTach - -
Amiodorone
Procainamide
LT treatment of WPW - -Amiodarone
Procainamide
Biopsy for Crohn's? - -Skip lesions
Transmural
What would you do for someone with Mobitz Cobblestone appearance
Type 1 Block - -Atropine
Cobblestone appearance on colonoscopy -
Pt comes with 30 sec LOC and confused -Crohn's
afterwards. What type of szr is this? - -
Tonic clonic
Barium flow through narrowed inflamed/scarred
area due to transmural strictures - -Crohn's
Masked facies: loss of facial expressions -
-Parkinson's Dz
IBD P-ANCA, ASCA - -P-ANCA: UC
ASCA: CROHN'S
Girl presents with a spot on her cheek that
itches, next day she is covered in rash with
pustule with erythematous base - - Skip lesions - -Crohn's colonoscopy
Varicella
Initial management for spinal stenosis - -
Pt presents with DKA to ED. What kind of insulin Lumbar epidural steroid injection of CTS
