FREE Internal Medicine Board Review Trivia Questions and Answers
Differential cell count, total protein, pH, glucose, amylase, triglycerides, microbiology, and cytology. Effusions must meet a minimum of one requirement (Light's requirement).
1) Pleural/serum protein: >0.5
2) > 0.6 LDH (pleural/serum)
3) LDH above three times the average serum LDH
1) Cardiac enzymes to rule out MI
2) Echocardiogram to estimate EF
3) Chest x-ray to look for cardiomegaly, and pulmonary edema and rule out COPD
4) EKG
5) CBC (anemia)
Explanation:
If a patient is suspected to have congestive heart failure (CHF), the following tests may be ordered to confirm the diagnosis and assess the severity of the condition:
1. Chest X-ray: This is used to look for signs of cardiomegaly (enlargement of the heart) and pulmonary edema (fluid in the lungs), and to rule out chronic obstructive pulmonary disease (COPD), which can mimic CHF symptoms.
2. Electrocardiogram (EKG): This is used to evaluate the electrical activity of the heart and look for signs of cardiac ischemia (reduced blood flow) or arrhythmias (abnormal heart rhythms).
3. Cardiac enzymes: These are blood tests that can help rule out myocardial infarction (MI or heart attack) as a cause of CHF symptoms.
4. Complete blood count (CBC): This is used to evaluate for anemia, which can exacerbate CHF symptoms.
5. Echocardiogram: This is a non-invasive imaging test that uses sound waves to create a picture of the heart and its function. It is used to estimate the ejection fraction (EF), which is a measure of how well the heart is pumping blood, and to identify any structural abnormalities or valve dysfunction that may be contributing to CHF symptoms.
Other tests that may be ordered to evaluate CHF include a B-type natriuretic peptide (BNP) blood test, a stress test, or cardiac catheterization. Treatment of CHF will depend on the severity of the condition and may include lifestyle modifications, medications, or in severe cases, surgery or heart transplantation.
When symptoms persist despite receiving the best care possible from b-blockers, ACEI, diuretics, and aldosterone antagonists in patients with EF 40%, digoxin should be given.
Explanation:
Digoxin is a medication that can be used in patients with congestive heart failure (CHF) who continue to have symptoms despite optimal treatment with beta-blockers, ACE inhibitors, diuretics, and aldosterone antagonists. Digoxin is a cardiac glycoside that helps to increase the strength of the heart's contractions, which can improve symptoms and quality of life in patients with CHF.
1) Both IV antibiotics and IV hydration
2) Monitor blood pressure and urine output; once symptoms have subsided for 48 hours, perform an ERCP to determine the cause
3) The most significant consequence is a liver abscess.
Explanation:
Cholangitis is a bacterial infection of the bile ducts, which can be a serious and potentially life-threatening condition. The treatment for cholangitis typically involves a combination of antibiotics and supportive care, as well as addressing the underlying cause of the infection.
It was shown for patients with A. Rate control outperformed rhythm control.
Explanation:
The AFFIRM trial was a landmark clinical trial conducted in the early 2000s that compared two strategies for managing patients with atrial fibrillation (A. Fib.): rate control and rhythm control. The study involved over 4000 patients with A. Fib. who were randomly assigned to either a rate control or rhythm control strategy and followed for an average of 3.5 years.
It was shown for patients with A. Rate control outperformed rhythm control.
Explanation:
An acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sudden worsening of symptoms, such as increased breathlessness, cough, and sputum production. The following steps should be taken to control a patient with an acute exacerbation of COPD:
1. CXR: A chest X-ray should be performed to evaluate for pneumonia, pneumothorax, or other acute pulmonary pathologies.
2. Inhaled bronchodilators: Inhaled short-acting beta-agonists (SABAs) and anticholinergic medications should be given to help relieve bronchospasm and improve airflow.
3. IV corticosteroids: Intravenous corticosteroids (such as methylprednisolone) should be given to reduce inflammation and improve lung function. The dose and duration of treatment may vary depending on the severity of the exacerbation.
4. Antibiotics: Antibiotics may be necessary in cases where a bacterial infection is suspected or confirmed.
5. Oxygen supplementation: Oxygen therapy should be provided to maintain an adequate oxygen saturation (SpO2) level, usually between 88-92%.
6. Non-invasive positive pressure ventilation (NPPV): NPPV may be considered in patients with severe respiratory distress or hypercapnic respiratory failure who are not responding to other treatments.
Overall, the management of acute exacerbations of COPD involves a combination of bronchodilators, corticosteroids, antibiotics, oxygen supplementation, and supportive care. Close monitoring of symptoms and response to treatment is essential to optimize outcomes and prevent complications.
1) RVH
2) VSF
3) Overriding Aorta
4) Pulmonary Artery Stenosis
Explanation:
The four features of the Tetralogy of Fallot are:
Ventricular Septal Defect (VSD): A hole in the wall (septum) between the two lower chambers of the heart (ventricles).
Right Ventricular Hypertrophy (RVH): The right ventricle of the heart is enlarged due to the increased workload needed to pump blood through the narrowed pulmonary valve.
Pulmonary Artery Stenosis: A narrowing or obstruction of the pulmonary artery that carries blood from the right ventricle to the lungs.
Overriding Aorta: The aorta, which carries oxygen-rich blood from the left ventricle, is shifted over the VSD, which allows oxygen-poor blood from the right ventricle to be pumped into the aorta and circulated to the body.
Together, these four features cause mixed blood flow, where oxygen-poor blood from the right side of the heart mixes with oxygen-rich blood from the left side of the heart, leading to cyanosis (a blue tint to the skin and lips).