Cardiology and Thyroid Health Quiz

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Questions and Answers

A ______ rhythm is characterized by three or more consecutive beats with a QRS rate of 120 bpm.

tachycardia

The presence of a short PR interval followed by a QRS duration greater than 120 ms, with a slurred initial deflection, indicates a ______ pattern.

Wolff-Parkinson-White

A prolonged ______ interval can lead to undulating rotation of the QRS complex around the EKG baseline, particularly in patients with electrolyte imbalances.

QT

A regular rhythm with a rate between 150 and 220 bpm is often associated with ______.

<p>supraventricular tachycardia</p>
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Patients with renal failure, crush injuries, or burn victims may exhibit peaked T-waves, widened QRS, short QT, and prolonged ______ on an ECG.

<p>PR</p>
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Medullary thyroid cancer is often associated with ______ II.

<p>MEN</p>
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Anaplastic thyroid cancer has a high mortality rate, with an estimated 80% of patients dying within the first ______.

<p>year</p>
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Hashimoto's thyroiditis can increase the risk of developing ______ lymphoma.

<p>thyroid</p>
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Osteoporosis, central fat deposition, diabetes, and hirsutism are all potential signs of ______ syndrome.

<p>Cushing's</p>
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The best screening tests for Cushing's syndrome are the 1mg overnight dexamethasone suppression test or a 24-hour ______ cortisol test.

<p>urine</p>
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The diagnosis of diabetes requires a fasting glucose level of ______ mg/dL or higher on two separate occasions.

<p>126</p>
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A blood glucose level of 400 mg/dL with symptoms like nausea, vomiting, abdominal pain, Kussmaul respirations, and coma is indicative of ______ ketoacidosis.

<p>diabetic</p>
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The treatment for diabetic ketoacidosis typically involves high-volume normal saline, insulin bolus and drip, and adding ______ once the patient begins urinating.

<p>potassium</p>
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A young, healthy patient with chest pain may be experiencing ______ if the pain worsens with inspiration and is relieved by leaning forward.

<p>pericarditis</p>
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If chest pain worsens with palpation, it may indicate ______.

<p>costochondriasis</p>
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In the case of vague chest pain accompanied by a history of viral infection and a murmur, the patient may have ______.

<p>myocarditis</p>
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Prinzmetal’s angina typically occurs at rest and can be diagnosed with an ergonovine ______ test.

<p>stimulation</p>
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The EKG buzzword for progressive prolongation of the PR interval followed by a ______ beat indicates a specific type of heart block.

<p>dropped</p>
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Cannon-a waves on physical examination suggest ______ in the context of irregular heart rhythms.

<p>atrial flutter</p>
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The presence of varying PR intervals with three or more morphologically distinct ______ waves in the same lead suggests a specific arrhythmia.

<p>P</p>
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______ medications such as calcium channel blockers or nitrates are used to treat Prinzmetal’s angina.

<p>Cardiac</p>
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The patient with pulsus paradoxus may show __________ heart sounds.

<p>distant</p>
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A patient with hyperthyroidism may present with an undulating baseline and __________ R-R interval.

<p>irregular</p>
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Aortic Stenosis may present with a systolic ejection murmur that is __________ with squatting.

<p>louder</p>
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In Hypertrophic Obstructive Cardiomyopathy (HOCM), the murmur is __________ with Valsalva.

<p>louder</p>
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A patient with Mitral Valve Prolapse may have a late systolic murmur with a __________.

<p>click</p>
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A Holosystolic murmur that radiates to the axilla may indicate __________.

<p>Mitral Regurgitation</p>
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In a patient diagnosed with a Pulmonary Embolism, common symptoms include pleuritic chest pain, __________, and tachypnea.

<p>hemoptysis</p>
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Light's Criteria is used to differentiate transudative from __________ pleural effusions.

<p>exudative</p>
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Pulmonary angiography is considered the ______ standard.

<p>gold</p>
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Start HAART when CD4 is less than ______ or viral load exceeds 55,000.

<p>350</p>
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The REPE regimen consists of 4 drugs to treat ______.

<p>tuberculosis</p>
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If a patient is suspected of having a pulmonary embolism, heparin should be given ______.

<p>first</p>
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In the diagnosis of ARDS, a PaO2/FiO2 ratio less than ______ indicates severe impairment.

<p>200</p>
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For HIV positive patients, prophylaxis for PCP should start when CD4 is below ______.

<p>200</p>
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A patient exhibiting dry cough and chest pain with a CD4 count of 35 likely has ______.

<p>PCP</p>
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Common side effects of Abacavir include HS rash, fever, and ______ in the first 6 weeks.

<p>muscle aches</p>
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A patient describes their headache as the 'worst headache of my life,' which may indicate ______.

<p>subarachnoid hemorrhage</p>
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Fever and nuchal rigidity are classic signs of ______.

<p>meningitis</p>
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Deep pain that wakes a patient up at night may suggest ______.

<p>brain tumor</p>
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Unilateral pounding headache alongside changes in vision could indicate ______.

<p>temporal arteritis</p>
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Elevated pressure on LP in the presence of normal CT findings might suggest ______.

<p>pseudotumor cerebri</p>
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CSF analysis showing albumino-cytologic dissociation is indicative of ______.

<p>Guillain-Barre</p>
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The first test in suspected cases of Myasthenia Gravis is to check for ______.

<p>Ach-ab</p>
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Courvoisier's sign, which indicates a large, nontender gallbladder, is associated with ______.

<p>adenocarcinoma</p>
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Flashcards

Ventricular tachycardia

Three or more consecutive beats with a QRS complex width greater than 120 milliseconds and a heart rate between 120 and 150 beats per minute.

Wolff-Parkinson-White (WPW) syndrome

A short PR interval followed by a wide QRS complex (greater than 120 milliseconds) with a slurred initial deflection. This reflects early ventricular activation via the bundle of Kent.

Atrial flutter

Regular rhythm with a ventricular rate of 125-150 beats per minute and an atrial rate of 250-300 beats per minute.

Supraventricular tachycardia (SVT)

A regular rhythm with a rate between 150-220 beats per minute. Often presents with palpitations or dizziness.

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Hyperkalemia (high potassium)

Peaked T-waves, a widened QRS complex, a shortened QT interval, and a prolonged PR interval. This may be seen in patients with renal failure, crush injuries, or burns.

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Pericarditis

A type of chest pain that is worse when breathing in, better when leaning forward, and may have a friction rub and diffuse ST elevation on ECG.

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Costochondritis

Chest pain that gets worse when you press on the chest wall.

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Myocarditis

A type of chest pain that occurs at rest, is worse at night, and may be associated with a history of viral infection, a heart murmur, and migraine headaches.

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Prinzmetal's angina

A type of chest pain that happens at rest, more often at night, and may have few CAD risk factors, along with transient ST elevation during episodes.

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Progressive PR prolongation with dropped beats

A pattern on an ECG where the time between the beginning of the P wave and the beginning of the QRS complex (PR interval) gradually gets longer until a heart beat is completely missed.

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Cannon 'A' Waves

A pattern on an ECG where the time between each P wave (P-P interval) and the time between each QRS complex (R-R interval) are regular, but there are large, prominent 'a' waves on physical exam.

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Variable PR interval with multiple P-wave morphologies

Characterized by a changing PR interval with 3 or more distinct looking P waves in the same ECG lead.

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Ergonovine stimulation test

A test used to diagnose Prinzmetal's angina by inducing coronary artery spasm with the medication ergonovine.

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ARDS (Acute Respiratory Distress Syndrome)

A condition characterized by inflammation in the lungs, leading to impaired gas exchange, release of inflammatory mediators, and hypoxemia.

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Pulmonary Embolism (PE)

A type of lung embolism caused by a blood clot that travels to the lungs, blocking blood flow.

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ABG (Arterial Blood Gas)

A test used to measure the amount of oxygen and carbon dioxide in the blood.

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Pulmonary Angiography

A procedure that uses a dye to visualize the blood vessels in the lungs, allowing for diagnosis of pulmonary embolism.

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Right Heart Strain

A medical condition that involves the enlargement of the right ventricle of the heart, often due to high blood pressure in the lungs.

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Sinus Tachycardia

A type of heart rhythm abnormality characterized by a rapid heartbeat.

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Pneumocystis jirovecii Pneumonia (PCP)

A type of infection that can cause pneumonia in people with weakened immune systems, particularly those with HIV/AIDS.

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HIV/AIDS

A condition caused by the human immunodeficiency virus (HIV) that weakens the immune system, making individuals susceptible to infections and cancers.

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What is Supraventricular Tachycardia (SVT)?

A rapid heart rhythm originating above the ventricles, often seen in patients with heart failure or valve disease. It can present with shortness of breath, dizziness, and palpitations.

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What is Atrial flutter?

A type of heart rhythm abnormality characterized by a rapid and regular beat rate with an atrial rate of 250-300 beats per minute. It can show as sawtooth-like waves on an ECG.

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What is Ventricular tachycardia?

A heart rhythm disturbance where three or more consecutive beats have wide QRS complexes (more than 120 milliseconds) and a heart rate between 120 and 150 beats per minute.

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What is Wolff-Parkinson-White (WPW) syndrome?

A condition marked by a shortened PR interval followed by a widened QRS complex (greater than 120 milliseconds) with a slurred initial deflection. It represents rapid electrical conduction through an abnormal pathway in the heart.

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What is Atrial fibrillation?

An irregular heart rhythm characterized by an undulating baseline with no distinct p-waves and variable R-R intervals. It is often found in hyperthyroid patients.

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What is Pulsus paradoxus?

A condition where the difference between the systolic blood pressure measured at the brachial artery and the systolic pressure measured during inspiration (when taking a deep breath) is 10mmHg or greater. It can be associated with cardiac tamponade, pericarditis, or severe asthma.

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What is Hypotension?

An abnormally low blood pressure, which can be caused by various factors, including cardiac tamponade, fluid loss, or sepsis.

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What is Jugular vein distention (JVD)?

An increase in the jugular vein distention, indicating increased pressure in the right atrium. It can be a sign of heart failure, pulmonary hypertension, or tricuspid valve stenosis.

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Anaplastic Thyroid Cancer

A rare and aggressive thyroid cancer with a poor prognosis, characterized by rapid growth and spread. It accounts for a small percentage of thyroid cancers. Often develops in the context of a pre-existing thyroid condition.

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Cushing's Syndrome

A syndrome characterized by high levels of cortisol due to increased production by the adrenal glands, leading to symptoms like osteoporosis, central obesity, diabetes, and hirsutism.

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Diabetic Ketoacidosis (DKA)

A medical emergency characterized by a severe metabolic disturbance due to lack of insulin and high blood sugar levels. Symptoms include nausea, vomiting, abdominal pain, Kussmaul respirations, and coma.

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Right Posterior Cerebral Artery (PCA) Stroke

A type of stroke affecting the right posterior cerebral artery (PCA), resulting in specific neurological deficits. Symptoms include vertigo, vomiting, nystagmus, clumsiness, and weakness in the right arm.

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Status Epilepticus

A serious condition characterized by prolonged seizures without recovery of consciousness between seizures, requiring immediate medical attention.

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Partial Seizures

Seizures that start in a specific brain area, often causing localized symptoms such as arm twitching, feelings of déjà vu, or a burning rubber smell. May progress to Generalized Seizures.

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Generalized Seizures

Seizures affecting both hemispheres of the brain simultaneously, causing a loss of consciousness and various neurological manifestations. Types: Grand Mal, Absence, Myoclonic, Atonic.

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Absence Seizures

A type of generalized seizure characterized by brief periods of unresponsiveness (5-10 seconds) commonly seen in children. Often associated with a specific EEG pattern.

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Worst Headache of My Life

A sudden, severe headache, often described as the "worst headache of my life", that might be caused by bleeding in the space surrounding the brain (subarachnoid hemorrhage).

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Meningitis

An inflammation of the meninges, the membranes that surround the brain and spinal cord. It's usually caused by an infection and can be serious.

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Temporal Arteritis

A type of headache that is often described as throbbing and occurs on one side of the head. It can sometimes come with changes in vision and jaw pain.

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Pseudotumor Cerebri

A condition that causes an increase in pressure around the brain, often associated with overweight individuals or women taking birth control pills. It can cause headaches and vision problems.

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Guillain-Barré Syndrome

A rare but serious disorder that affects the nerves that control muscle movement. It causes weakness and paralysis that usually starts in the legs and spreads upwards.

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Myasthenia Gravis

A condition that weakens the muscles and makes them easily tired. It's caused by a problem with the communication between nerves and muscles.

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Chronic Pancreatitis

A condition where the pancreas is inflamed and damaged over time. It can cause chronic pain, diabetes (difficulty regulating blood sugar), and problems absorbing nutrients.

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Adenocarcinoma of the Pancreas

A type of cancer of the pancreas that often doesn't cause symptoms until it's advanced. If it occurs in the head of the pancreas, it can cause jaundice (yellowing of the skin and eyes) and a swollen gallbladder.

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Study Notes

High Yield Internal Medicine Shelf Exam Review

  • This review covers high-yield topics in internal medicine, suitable for shelf exam preparation.
  • Cardiology, pulmonology, infectious disease, and other relevant areas are included.
  • Key diagnostic approaches, tests, and treatments are emphasized.

Cardiology

  • Chest pain initial evaluation: EKG is the first test.
  • STEMI: 2mm or more ST elevation or new LBBB (wide, flat QRS complex). Immediately treat with reperfusion (cath lab or thrombolytics if no contraindications). ST elevation immediately, T wave inversion 6 hrs- years, Q waves last forever.
  • Anterior MI leads: V1-V4
  • Lateral MI leads: I, aVL, V4-V6
  • Inferior MI leads: II, III, and aVF
  • Right ventricular infarct: Hypotension, tachycardia, clear lungs, JVD, no pulsus paradoxus. Do not give nitro. Tx with vigorous fluid resuscitation.
  • NSTEMI: If cardiac enzymes are elevated, check enzymes q8hrs x 3.
  • Unstable angina: No ST elevation and normal cardiac enzymes x3. Workup: exercise EKG (avoid blockers and CCB before). If cannot do EKG stress test, do exercise echo. Chemical stress test (dobutamine or adenosine) can be done if pt cannot exercise. MUGA is nuclear medicine test to show perfusion of heart areas. Avoid caffeine and theophylline before test. If chest pain reproduces, ST depression, or hypotension, proceed to coronary angiography.
  • Post-MI complications: Arrhythmias (ventricular fibrillation), new systolic murmur (5-7 days after), acute severe hypotension, "step up" O2 concentration from RA to RV, persistent ST elevation 1 month later + systolic mitral regurgitation murmur, cannon A-waves, pleuritic chest pain and low-grade fever after 5-10 weeks.

Pulmonary

  • Shortness of breath: Suspect PE (history of cancer, surgery, or prolonged sitting) → administer heparin immediately.
  • pneumonia suspect: Check O2 sats, then get a chest x-ray.
  • CHF suspect: If murmur present or history of CHF, get an echocardiogram to check ejection fraction.
  • Acute pulmonary edema: Nitrates, lasix, and morphine.
  • Young patient with CHF sxs: Consider myocarditis (Coxsackie B) if prior history of viral infection.
  • No cardiomegaly on CXR in young patient: Consider primary pulmonary hypertension.
  • Right heart cath: To differentiate between CHF and pulmonary hypertension.
  • CXR buzzwords: Opacification, consolidation, air bronchograms, hyperlucent lung fields, flattened diaphragms, heart >50% AP diameter, cephalization, Kerly B lines, interstitial edema, cavity containing air-fluid level, upper lobe cavitation, consolidation, hilar adenopathy, thickend peritracheal stripe and splayed carina bifurcation.
  • Pleural Effusions: If fluid >1 cm on lateral decubitus X-ray, do thoracentesis. Transudative effusions are likely due to CHF, nephrotic syndrome, or cirrhosis. Exudative effusions are likely due to parapneumonic effusion, malignancy, or pulmonary embolism. If complicated (gram stain or cx, pH <7.2, glucose <60), insert a chest tube for drainage. Light's criteria for transudative effusions: LDH <200, LDH eff/serum <0.6, protein eff/serum <0.5.
  • Pulmonary Embolism: High risk after surgery, long car ride, hypercoagulable state (cancer, nephrotic syndrome). Symptoms include pleuritic chest pain, hemoptysis, tachypnea, decreased pO2, and tachycardia. If suspected, give heparin initially. Workup with V/Q scan, then spiral CT.
  • ARDS: Pathophysiology involves inflammation leading to impaired gas exchange and hypoxemia. Common causes include sepsis, gastric aspiration, trauma, and low perfusion. Diagnosis: PaO2/FiO2 <200 (<300 means acute lung injury), bilateral alveolar infiltrates on CXR, and PCWP <18 (means non-cardiogenic pulmonary edema). Treatment: mechanical ventilation with PEEP (positive end-expiratory pressure).
  • PFTs: Obstructive (Asthma, COPD, Emphysema) vs restrictive (Interstitial lung disease, obesity, muscle weakness, paralysis, scoliosis).

Infectious Diseases

  • Meningitis:
  • Common bugs (strep pneumo, H. influenza, N. meningitidis) in old and young, also Listeria, Staph.
  • Empiric Tx: Ceftriaxone ( + vancomycin in all cases), Ampicillin (Listeria), Vancomycin (Staph)
  • If hx of brain surgery, Add Staph aureus coverage (Vancomycin).
  • Pneumonia: Key bugs: Strep Pneumo (all cases), Mycoplasma (healthy young), Pseudomonas, Klebsiella, E. Coli (hospitalized), H. influenza (COPD), Legionella (old men, HA, confusion and diarrhea), Klebsiella (alcoholics with current jelly sputum), MRSA (hospitalized, flu-like symptoms), Coxiella burnetii (recent exposure to cats).
  • Tuberculosis: CXR is initial test for symptomatic patients >15mm ( >10 mm: prison, HC, nursing home, DM, ETOH, chronically ill patients; >5mm: AIDS, immune suppressed). PPD +CXR → acid-fast stain of sputum. CXR +3 negative sputums = negative TB. Treatment: 4-drug RIPE regimen.
  • Endocarditis: Staph aureus is common cause of acute endocarditis. Viridans strep is common in subacute native valve endocarditis. Tricuspid valve commonly affected in IVDU(intravenous drug users). Blood cultures, transthoracic echo (TTE) and transesophageal echo (TEE) are diagnostic. Treatment varies based on causative organisms.
  • HIV/AIDS: Symptoms suggestive of HIV require careful evaluation. Diagnoses confirmed by blood test.

Other Topics

  • CHF: Systolic vs diastolic dysfunction; key causes, treatment considerations.
  • Murmur Buzzwords: Crescendo-decrescendo (louder w/ squatting, softer w/ valsalva) – Aortic stenosis; Louder w/ valsalva, softer w/ squatting or handgrip – Hypertrophic Obstructive Cardiomyopathy (HOCM); Late systolic murmur w/ click, louder w/ valsalva & handgrip, softer w/ squatting – Mitral Valve Prolapse; Holosystolic murmur radiating to axilla w/ Left apical impulse (LAE) – Mitral Regurgitation; Wide fixed and split S2 – Atrial septal defect (ASD); Continuous machine-like murmur – Patent ductus arteriosus (PDA); Rumbling diastolic murmur w/ opening snap – Mitral stenosis; Blowing diastolic murmur w/ widened pulse pressure and an eponym parade – Aortic regurgitation.
  • Other relevant topics: Review pertinent points about GI, renal, and neurology topics as discussed in the lecture or written material. Always focus on high-yield content for the exam.

Disclaimer: This is a study guide and not a substitute for medical advice. Consult with a healthcare professional for any health concerns.

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