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Questions and Answers
A ______ rhythm is characterized by three or more consecutive beats with a QRS rate of 120 bpm.
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.
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.
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 ______.
A regular rhythm with a rate between 150 and 220 bpm is often associated with ______.
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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.
Patients with renal failure, crush injuries, or burn victims may exhibit peaked T-waves, widened QRS, short QT, and prolonged ______ on an ECG.
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Medullary thyroid cancer is often associated with ______ II.
Medullary thyroid cancer is often associated with ______ II.
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Anaplastic thyroid cancer has a high mortality rate, with an estimated 80% of patients dying within the first ______.
Anaplastic thyroid cancer has a high mortality rate, with an estimated 80% of patients dying within the first ______.
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Hashimoto's thyroiditis can increase the risk of developing ______ lymphoma.
Hashimoto's thyroiditis can increase the risk of developing ______ lymphoma.
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Osteoporosis, central fat deposition, diabetes, and hirsutism are all potential signs of ______ syndrome.
Osteoporosis, central fat deposition, diabetes, and hirsutism are all potential signs of ______ syndrome.
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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.
The best screening tests for Cushing's syndrome are the 1mg overnight dexamethasone suppression test or a 24-hour ______ cortisol test.
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The diagnosis of diabetes requires a fasting glucose level of ______ mg/dL or higher on two separate occasions.
The diagnosis of diabetes requires a fasting glucose level of ______ mg/dL or higher on two separate occasions.
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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.
A blood glucose level of 400 mg/dL with symptoms like nausea, vomiting, abdominal pain, Kussmaul respirations, and coma is indicative of ______ ketoacidosis.
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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.
The treatment for diabetic ketoacidosis typically involves high-volume normal saline, insulin bolus and drip, and adding ______ once the patient begins urinating.
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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.
A young, healthy patient with chest pain may be experiencing ______ if the pain worsens with inspiration and is relieved by leaning forward.
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If chest pain worsens with palpation, it may indicate ______.
If chest pain worsens with palpation, it may indicate ______.
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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 ______.
In the case of vague chest pain accompanied by a history of viral infection and a murmur, the patient may have ______.
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Prinzmetal’s angina typically occurs at rest and can be diagnosed with an ergonovine ______ test.
Prinzmetal’s angina typically occurs at rest and can be diagnosed with an ergonovine ______ test.
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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.
The EKG buzzword for progressive prolongation of the PR interval followed by a ______ beat indicates a specific type of heart block.
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Cannon-a waves on physical examination suggest ______ in the context of irregular heart rhythms.
Cannon-a waves on physical examination suggest ______ in the context of irregular heart rhythms.
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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.
The presence of varying PR intervals with three or more morphologically distinct ______ waves in the same lead suggests a specific arrhythmia.
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______ medications such as calcium channel blockers or nitrates are used to treat Prinzmetal’s angina.
______ medications such as calcium channel blockers or nitrates are used to treat Prinzmetal’s angina.
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The patient with pulsus paradoxus may show __________ heart sounds.
The patient with pulsus paradoxus may show __________ heart sounds.
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A patient with hyperthyroidism may present with an undulating baseline and __________ R-R interval.
A patient with hyperthyroidism may present with an undulating baseline and __________ R-R interval.
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Aortic Stenosis may present with a systolic ejection murmur that is __________ with squatting.
Aortic Stenosis may present with a systolic ejection murmur that is __________ with squatting.
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In Hypertrophic Obstructive Cardiomyopathy (HOCM), the murmur is __________ with Valsalva.
In Hypertrophic Obstructive Cardiomyopathy (HOCM), the murmur is __________ with Valsalva.
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A patient with Mitral Valve Prolapse may have a late systolic murmur with a __________.
A patient with Mitral Valve Prolapse may have a late systolic murmur with a __________.
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A Holosystolic murmur that radiates to the axilla may indicate __________.
A Holosystolic murmur that radiates to the axilla may indicate __________.
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In a patient diagnosed with a Pulmonary Embolism, common symptoms include pleuritic chest pain, __________, and tachypnea.
In a patient diagnosed with a Pulmonary Embolism, common symptoms include pleuritic chest pain, __________, and tachypnea.
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Light's Criteria is used to differentiate transudative from __________ pleural effusions.
Light's Criteria is used to differentiate transudative from __________ pleural effusions.
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Pulmonary angiography is considered the ______ standard.
Pulmonary angiography is considered the ______ standard.
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Start HAART when CD4 is less than ______ or viral load exceeds 55,000.
Start HAART when CD4 is less than ______ or viral load exceeds 55,000.
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The REPE regimen consists of 4 drugs to treat ______.
The REPE regimen consists of 4 drugs to treat ______.
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If a patient is suspected of having a pulmonary embolism, heparin should be given ______.
If a patient is suspected of having a pulmonary embolism, heparin should be given ______.
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In the diagnosis of ARDS, a PaO2/FiO2 ratio less than ______ indicates severe impairment.
In the diagnosis of ARDS, a PaO2/FiO2 ratio less than ______ indicates severe impairment.
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For HIV positive patients, prophylaxis for PCP should start when CD4 is below ______.
For HIV positive patients, prophylaxis for PCP should start when CD4 is below ______.
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A patient exhibiting dry cough and chest pain with a CD4 count of 35 likely has ______.
A patient exhibiting dry cough and chest pain with a CD4 count of 35 likely has ______.
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Common side effects of Abacavir include HS rash, fever, and ______ in the first 6 weeks.
Common side effects of Abacavir include HS rash, fever, and ______ in the first 6 weeks.
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A patient describes their headache as the 'worst headache of my life,' which may indicate ______.
A patient describes their headache as the 'worst headache of my life,' which may indicate ______.
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Fever and nuchal rigidity are classic signs of ______.
Fever and nuchal rigidity are classic signs of ______.
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Deep pain that wakes a patient up at night may suggest ______.
Deep pain that wakes a patient up at night may suggest ______.
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Unilateral pounding headache alongside changes in vision could indicate ______.
Unilateral pounding headache alongside changes in vision could indicate ______.
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Elevated pressure on LP in the presence of normal CT findings might suggest ______.
Elevated pressure on LP in the presence of normal CT findings might suggest ______.
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CSF analysis showing albumino-cytologic dissociation is indicative of ______.
CSF analysis showing albumino-cytologic dissociation is indicative of ______.
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The first test in suspected cases of Myasthenia Gravis is to check for ______.
The first test in suspected cases of Myasthenia Gravis is to check for ______.
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Courvoisier's sign, which indicates a large, nontender gallbladder, is associated with ______.
Courvoisier's sign, which indicates a large, nontender gallbladder, is associated with ______.
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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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