MedCertNP's Hot Topics includes a brief review of FREQUENTLY TESTED material. Using the internal medicine specialties listed in the column to the right, chose a topic and quickly review it's content.  
     Remember all information about a topic will not be included on the slide, just the frequently tested material. The topic will be at the top of the page. The listed bullet points will follow in a standard format as shown below. You can add additional information, comments, or upload study slides or tables you may have developed related to the topic (or specialty. . . we can always add a new topic).
     Remember, the listed points are THE ABSOLUTE LEAST that you should know about a topic (and more is always better). Please commit these points to memory.  Once memorized, your mind will group the information together, and when a question is presented the correct answer will seem more obvious based on the constellation of grouped symptoms. When taking an exam a lot of extra clinical information is given as a filler, or distractor.
     Once the basics of a diagnosis is known, you can look for verifying data before you choose an answer, and it makes "guessing" much more scientifically based.
     If the Hot Topics quick review leaves you lost (which will happen occasionally), grab a text (Current Diagnosis & Treatment) and read in more depth, then come back and continue.
service-img07Topic
  • Clinical overview
  • Clinical presentation
  • Signs and symptoms
  • Laboratories and studies
  • Diagnosis
  • Treatment

Please refer to standard Medical texts for a complete review of any topic. This information is for exam purposes only and should not be used for actual patient care. Very few disorders lend themselves to such a brief synopsis, and actual patient care deserves a more intense and exhaustive survey of a disease.

How is the Weber test done

and

what does it determine?

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A vibrating tuning fork is placed in the middle of the forehead, above the upper lip under the nose over the teeth, or on top of the head equi-distant from the patient's ears on top of thin skin in contact with the bone.

The patient is asked to report in which ear the sound is heard louder. A normal weber test has a patient reporting the sound heard equally in both sides.

In an affected patient, if the defective ear hears the Weber tuning fork louder, the finding indicates a conductive hearing loss in the defective ear.

What is the formula for calculating the

"Corrected Calcium"

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Corrected Calcium =

Serum Ca + [0.8 x ( 4 - patient's albumin)]

Positive "Chvostek sign"

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Vitamin D deficiency

Chvostek sign: Contraction of the muscles of the eye, mouth, or nose by tapping along the facial nerve

A pregnant patient presents with new A Fib,

what should you consider?

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Mitral Stenosis

Secundum ASD

Broad Waxy Casts

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Chronic Renal Failure

Granular and waxy casts are be believed to come from renal tubular cell casts.

Broad casts come from damaged and dilated tubules and are therefore seen in end-stage chronic renal disease.

What is the first abnormal change in Diabetes Type 2?

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Abnormal glucose elevations after meals.

(Postprandial hyperglycemia)

List 6 common side effects of

long-term steroid use?

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  1. Glucose Intolerance

  2. Weight gain

  3. Osteoporosis

  4. Cataracts

  5. Avascular necrosis

  6. Insomnia

What is the Rinne test

and

what does it determine?

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A vibrating tuning fork (typically 512 Hz) is placed initially on the mastoid process behind each ear until sound is no longer heard. Then, the fork is then immediately placed just outside the ear with the patient asked to report when the sound caused by the vibration is no longer heard.

A normal or positive Rinne test is when the sound heard outside of the ear (air conduction or AC) is louder than that heard of the initial sound heard when the tuning fork end was placed against the skin on top of the mastoid process behind the ear (bone conduction or BC).

Therefore, AC > BC; which is how it is reported clinically for a normal or positive Rinne result. In conductive hearing loss, bone conduction is better than air or BC > AC, a negative Rinne.

Which preventative measure offers the most benefit?

Pap, Mammogram, Colonoscopy, PSA, Chest X-ray (in smokers)

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Mammogram

Mammo_breast_cancer (1)

Urinary Renal Tubular Casts

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1.) Acute Tubular Necrosis
2.) Interstitial Nephritis

What is the most common form of cancer?

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Skin Cancer

basal-cell-carcinoma

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Basal Cell Carcinoma

When is a BNP result helpful?

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When it is normal.

An elevated BNP rarely decreases your differential whereas a normal BNP rules out CHF.

Gram negative cocci in pairs

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Neisseria meningitidis

Criteria distinguishing

osteoporosis vs osteopenia

on DEXA scan?

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Osteopenia: T-score 1 - 2.5 SD below normal

Osteoporosis: T-score > 2.5 SD below normal

Treat all with Vit D, calcium, and exercise.

Bisphosphonates for osteoporosis (weigh risk/benefit)

If the history suggests a pituitary tumor,

what 5 tasks are in your work-up?

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1. Check MRI

2. Prolactin level

3. IGL-1 (for acromegaly)

4. 24 hour urine cortisol or ACTH stimulation test

5. TSH/T4

What is the "classic" initial treatment of Type 2 Diabetes Mellitus

in obese, non-obese, elderly, and Asians?

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kaysler

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Kayser-Fleischer rings

They are gold (flourescent) rings that appear to encircle the iris. They are due to copper deposition in the cornea as a result of Wilson's (liver) disease.

 

 

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A red blood cell transfusion is recommended for hospitalized patients with coronary heart disease, with the trigger hemoglobin threshold at 7-8 g/dL

Where is "Kiesselbach's Plexus"?

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Most common location for nosebleeds.

pneumothorax

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Pneumothorax

What is the impact of statins versus other lipid lowering medications?

 

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Satins decrease cardiac events and mortality by 30 to 40%

Niacin decreases cardiac events & mortality by 11%

Gemfibrozil & cholestyramine decrease cardiac endpoints, but do NOT decrease mortality.

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Impetigo

Most common arrhythmia resulting from

cardiac valvular disease? 

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Atrial Fibrillation

paget1

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Paget Disease

This is a bone scan showing increased uptake in the left femur. Paget disease is a localized disorder of bone remodeling that typically begins with excessive bone resorption followed by an increase in bone formation.

What is the common form of skin cancer?

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Basal Cell Carcinoma

Small pupil accommodates, but does not constrict.

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 Argil Robertson pupil

Argil Robertson pupil can also appear in Herpes Zoster infection but it is classically associated with syphilis. Argyll Robertson pupils ("Prostitute's Pupil") are bilateral small pupils that constrict when the patient focuses on a near object (they “accommodate”), but do not constrict when exposed to bright light (they do not “react” to light). Penicillin is the treatment of choice for treating syphilis

Kayser-Fleischer rings

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Wilson's Disease

What are the most common renal stones?

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Calcium Oxalate stones

File:Calcium oxalate resonance.png

What 3 disorders cause a persistently split S2?

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A persistently split S2 does NOT disappear on exhalation.

1.) Pulmonary embolism

2.) Pulmonic stenosis

3.) Right Bundle Branch Block

What is the "classic" triad associated with

Reiter Syndrome?

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Arthritis

Nongonococcal urethritis

Conjunctivitis (uveitis)

Acromegaly1

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Acromegaly

_____?_____ is under tonic inhibition by dopamine

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Prolactin

Things that antagonize dopamine INCREASE prolactin (metclopramide (reglan) & phenothiazines(compazine).

A pregnant woman has a UTI,

What antibiotic can you use?

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Oral antibiotics are the treatment of choice for asymptomatic bacteriuria and frank cystitis. Appropriate oral regimens include the following:

  • Cephalexin 500 mg 4 times daily
  • Ampicillin 500 mg 4 times daily
  • Nitrofurantoin 100 mg twice daily
  • Sulfisoxazole 1 g 4 times daily

Gram Positive Cocci in clusters

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Staphylococcus aureus

??

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Leukoplakia

  • Oral leukoplakia is defined as “a white patch or plaque that cannot be characterized clinically or pathologically as any other disease” thus a diagnosis by exclusion.
  • The term is strictly a CLINICAL one and does not imply a specific histopathologic tissue alteration.
  • Leukoplakia is the most common oral pre-cancer.
  • Leukoplakia usually affects people over the age of 40 years (average age is 60 years).

Most common complication of

"The Flu"

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Bacterial Pneumonia

A solitary papule with the "dimple sign"

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Dermatofibromas

These typically arise slowly and most often occur as a solitary nodule on an extremity, particularly the lower leg, but any cutaneous site is possible. They are usually asymptomatic, but itching and pain often are noted. They are the most common of all painful skin tumors. No treatment is usually necessary.

Hyaline Casts

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1.) Fever
2.) Diuretic
3.) Exercise

Hyaline casts are composed primarily of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells.  Hyaline casts can be seen in healthy patients.

calcified-gb2
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Calcified Gall Bladder

Surgery is usually indicated.

How long should a patient fast before drawing a lipid level?

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12 hours

What interventions have been shown to

decrease mortality

after MI?

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  1. Aspirin

  2. ACE Inhibitors

  3. Statins

  4. Beta Blockers

Autosomal Dominant Polycystic Kidney Disease

is associated with what

five conditions?

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1.) Cerebral aneurysms

2.) Hepatic cysts

3.) Hypertension

4.) Thoracic aortic aneurysms (Not abdominal aortic aneurysms)

5.) Increased HCT (increased erythropoietin secretion from cysts)

Up to 50% of patients with ADPKD require renal replacement therapy by 60 years of age.

"Herald Patch" is seen when?

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Pityriasis rosea

Gram Positive Cocci in Chains

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Streptococcus agalactiae

This is "classically" associated with what disorder?

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COPD

(chronic hypoxia)

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Scabies

Osteoporosis Risk Factors

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Fracture in 1st Degree Relative
Wt < 127 or BMI < 20
ETOH > 3 drinks/day
Menopause before 40
Glucocorticoid > 3 months at > 5mg/day

What is the best initial test to diagnose pericarditis?

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ECG

ekg_pericarditis_stelevation

Treatment of choice for

pediculosis?

Louse

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Permethrin

(pediculosis are lice)

What is the significant age for a

family history of CAD?

Family

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Under 55 for a male relative

Under 65 for a female relative

Please don't be fooled by a father with an MI at 62 or a mother with CABG at 70 as representing "increased risk to a patient."

anti-cyclic citrullinated peptide antibody / Anti CCP positive

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Rheumatoid Arthritis

Hepatitis C arthritis looks like RA, Rh Factor is very positive, Anti-CCP is negative.  Look for this!!

List the three common causes of

secondary hyperlipidemia.

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1. ) Diabetes 
2.) Renal Disease (Nephrotic Syndrome)
3.) Hypothyroidism

Name the general defects in Microcytic Anemias. (3)

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1.) Heme synthesis defect (Fe+ def. & "chronic disease")

2.) Globin synthesis defect (Thalassemia, etc.)

3.) Sideroblastic defect (Sideroblastic anemia, lead toxicity, etc.)

Gram positive cocci in pairs and chains.

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Streptococcus pneumoniae

Condylomata-acuminata-female
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Condylomata acuminata

Who should be routinely screened for Vitamin D deficiency?

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~Patients with osteoporosis

~Patients with a malabsorption syndrome

~Black and Hispanic individuals

~Obese persons (BMI >30 kg/m2)

~Patients with disorders that affect the metabolism of vitamin D and phosphate (eg, chronic kidney disease, etc.)

Diastolic blowing high pitched murmur

Heard best at the lower left sternal border (when leaning forward)

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Aortic Regurgitation

What does "CREST" stand for?

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Calcinosis

Raynaud

Esophageal dysmobility

Sclerodactyly

Telangiectasia

What segment of the population should avoid multivitamins with

beta carotene / Vitamin A?

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Smokers

 

For whatever reason, smokers on Vitamin A supplements have an increased risk for lung cancer.

What are the types of insulin

and their duration of action?

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