High Yield Internal Medicine: Self Exam Review

Author: Dr. Muhammad Ismail

Quick Review for FCPS / MRCP / USMLE

Table of Contents

Cardiology
- Acute Coronary Syndromes
- Post-MI Complications
- Pericarditis and Myocarditis
- EKG Buzzwords
- Murmur Buzzwords
Pulmonology
- CXR Buzzwords
- Pleural Effusions
- Pulmonary Embolism
- ARDS
- PFTs
- COPD
- Asthma
- Restrictive Lung Diseases
- Pulmonary Nodules
- Lung Cancer
Gastroenterology
- Inflammatory Bowel Disease
- Liver Function Tests and Lab Buzzwords
- Esophageal Disorders
- Gastric and Duodenal Ulcers
- Biliary and Pancreatic Disorders
- Diarrhea
Infectious Disease
- Meningitis
- Pneumonia
- Tuberculosis
- Endocarditis
- HIV
- Neutropenic Fever
- Random Infection Buzzwords
Nephrology
- Electrolyte Abnormalities
- Acid-Base Disorders
- Renal Tubular Acidoses
- Acute Renal Failure
- Chronic Kidney Disease
- Hematuria and Proteinuria
- Kidney Stones
Hematology/Oncology
- Anemia
- Thrombocytopenia
- Coagulopathies
- Leukemia
- Lymphoma
- Multiple Myeloma
- Polycythemia Vera
Rheumatology/Dermatology
- Arthritis
- Antibodies to Know
- Skin Signs of Systemic Diseases
- Skin Cancer
Endocrinology
- Pituitary Disorders
- Thyroid Disorders
- Adrenal Disorders
- Parathyroid Disease
- Diabetes
Neurology
- Stroke
- Seizures
- EEG Buzzwords
- Headache
- Neuromuscular Disorders

Chapter 1: Cardiology

Acute Coronary Syndromes

STEMI: 2mm ST elevation or new LBBB on EKG. Immediate reperfusion via cath lab or thrombolytics.
NSTEMI: Elevated cardiac enzymes. Treat with morphine, oxygen, nitrates, aspirin/clopidogrel, and beta-blockers.
Unstable Angina: No ST elevation and normal cardiac enzymes. Workup includes stress tests and angiography.

Post-MI Complications

Ventricular Free Wall Rupture: Acute severe hypotension.
Ventricular Septal Rupture: "Step up" in O2 concentration from RAP to RV.
Dressler's Syndrome: Autoimmune pericarditis 5-10 weeks post-MI.

Pericarditis and Myocarditis

Pericarditis: Chest pain worse with inspiration, better with leaning forward, friction rub, and diffuse ST elevation.
Myocarditis: Vague chest pain with history of viral infection and murmur.

EKG Buzzwords

Mobitz Type I (Wenckebach): Progressive PR prolongation followed by a dropped beat.
Atrial Fibrillation: Irregularly irregular rhythm with no P waves.

Murmur Buzzwords

Aortic Stenosis: Crescendo-decrescendo systolic murmur, louder with squatting.
Mitral Regurgitation: Holosystolic murmur radiating to the axilla.

Chapter 2: Pulmonology

CXR Buzzwords

Consolidation: Air bronchograms, lobar consolidation.
COPD: Hyperlucent lung fields, flattened diaphragms.

Pleural Effusions

Transudative: CHF, nephrotic syndrome, cirrhosis.
Exudative: Parapneumonic, cancer, TB.

Pulmonary Embolism

Symptoms: Pleuritic chest pain, hemoptysis, tachypnea.
Treatment: Heparin, warfarin, thrombolytics if severe.

ARDS

Diagnosis: PaO2/FiO2 < 200, bilateral alveolar infiltrates, PCWP < 18.
Treatment: Mechanical ventilation with PEEP.

PFTs

Obstructive: FEV1/FVC < 80%, TLC > 120%.
Restrictive: FEV1/FVC normal, TLC < 80%.

COPD

Treatment: Ipratropium, beta-agonists, theophylline.
Oxygen Therapy: PaO2 < 55 or SpO2 < 88%.

Asthma

Management: Albuterol, inhaled corticosteroids, long-acting beta-agonists.
Exacerbation: Inhaled albuterol, PO/IV steroids.

Restrictive Lung Diseases

Silicosis: Upper lobe nodules, eggshell calcifications.
Sarcoidosis: Hilar lymphadenopathy, erythema nodosum.

Pulmonary Nodules

Benign: Popcorn calcification (hamartoma), concentric calcification (old granuloma).
Malignant: >3cm, eccentric calcification, risk factors (smoking, age).

Lung Cancer

Adenocarcinoma: Most common in non-smokers, peripheral.
Small Cell: Central, associated with paraneoplastic syndromes.

Chapter 3: Gastroenterology

Inflammatory Bowel Disease

Crohn's Disease: Terminal ileum involvement, fistulae, granulomas.
Ulcerative Colitis: Continuous inflammation from rectum, higher risk of colon cancer.

Liver Function Tests and Lab Buzzwords

Alcoholic Hepatitis: AST > ALT, high GGT.
Viral Hepatitis: ALT > AST, elevated in the 1000s.

Esophageal Disorders

Achalasia: Dysphagia to liquids and solids, manometry is diagnostic.
GERD: Epigastric pain worse after eating, 24-hour pH monitoring.

Gastric and Duodenal Ulcers

Gastric Ulcers: Pain worse with eating, associated with H. pylori, NSAIDs.
Duodenal Ulcers: Pain better with eating, 95% associated with H. pylori.

Biliary and Pancreatic Disorders

Acute Cholecystitis: RUQ pain, fever, Murphy's sign, U/S shows thickened wall.
Acute Pancreatitis: Epigastric pain radiating to back, elevated amylase/lipase.

Diarrhea

Infectious: Viral (rotavirus, Norwalk), bacterial (EHEC, Shigella).
Non-Infectious: Celiac disease, chronic pancreatitis, carcinoid syndrome.

Chapter 4: Infectious Disease

Meningitis

Bacterial: Strep pneumo, H. influenzae, N. meningitidis.
Treatment: Empiric antibiotics (ceftriaxone, vancomycin), steroids.

Pneumonia

Community-Acquired: Strep pneumo, Mycoplasma.
Hospital-Acquired: Pseudomonas, Klebsiella, MRSA.

Tuberculosis

Diagnosis: CXR, PPD, acid-fast stain of sputum.
Treatment: RIPE regimen (Rifampin, INH, Pyrazinamide, Ethambutol).

Endocarditis

Acute: Staph aureus, native valves.
Subacute: Viridans group strep, mitral valve.

HIV

Acute Retroviral Syndrome: Fever, fatigue, lymphadenopathy.
Opportunistic Infections: PCP, CMV, MAC, Cryptosporidium.

Neutropenic Fever

Definition: Temp > 101.3, ANC < 500.
Treatment: Broad-spectrum antibiotics (ceftazidime, vancomycin).

Random Infection Buzzwords

Lyme Disease: Target rash, fever, VII palsy, AV block.
Rocky Mountain Spotted Fever: Rash on wrists/ankles, fever, headache.

Chapter 5: Nephrology

Electrolyte Abnormalities

Hyponatremia: SIADH, CHF, cirrhosis.
Hyperkalemia: Peaked T waves, prolonged PR/QRS, sine waves.

Acid-Base Disorders

Metabolic Acidosis: MUDPILES (Methanol, Uremia, DKA, etc.).
Respiratory Alkalosis: Hyperventilation (anxiety, pain, salicylates).

Renal Tubular Acidoses

Type I (Distal): Hypokalemia, kidney stones, urine pH > 5.5.
Type II (Proximal): Hypokalemia, Fanconi syndrome.

Acute Renal Failure

Prerenal: BUN/Cr > 20, FENa < 1%.
Intrinsic: ATN, AIN, rhabdomyolysis.

Chronic Kidney Disease

Causes: DM, HTN.
Complications: HTN, anemia, hyperphosphatemia, uremia.

Hematuria and Proteinuria

Glomerular Hematuria: Dysmorphic RBCs, RBC casts.
Nephrotic Syndrome: Proteinuria > 3.5g/24hr, hypoalbuminemia, edema.

Kidney Stones

Calcium Oxalate: Most common type, treat with HCTZ.
Uric Acid: Alkalinize urine, hydrate.

Chapter 6: Hematology/Oncology

Anemia

Microcytic: Iron deficiency, thalassemia, anemia of chronic disease.
Macrocytic: B12/folate deficiency, alcohol, liver disease.

Thrombocytopenia

ITP: Isolated thrombocytopenia, treat with steroids.
TTP: MAHA, fever, AMS, treat with plasmapheresis.

Coagulopathies

Hemophilia A: Factor VIII deficiency, prolonged PTT.
Vitamin K Deficiency: Prolonged PT, treat with vitamin K.

Leukemia

ALL: Most common in kids, TdT positive.
AML: Auer rods, myeloperoxidase positive.

Lymphoma

Hodgkin's: Reed-Sternberg cells, orderly spread.
Non-Hodgkin's: Extra-nodal involvement, aggressive.

Multiple Myeloma

Diagnosis: Serum protein electrophoresis (IgG spike), bone marrow biopsy.
Treatment: Melphalan, prednisone, BM transplant.

Polycythemia Vera

Symptoms: Pruritis after hot bath, Hct > 60%.
Treatment: Phlebotomy, hydroxyurea.

Chapter 7: Rheumatology/Dermatology

Arthritis

OA: Knee pain, DIP involvement, crepitus.
RA: Symmetric PIP/wrist involvement, morning stiffness.

Antibodies to Know

SLE: ANA, anti-dsDNA, anti-Smith.
RA: RF, anti-CCP.

Skin Signs of Systemic Diseases

Dermatomyositis: Heliotrope rash, Gottron's papules.
Erythema Multiforme: Target lesions, often drug-induced.

Skin Cancer

Basal Cell Carcinoma: Pearly papule, ulceration.
Melanoma: Asymmetric, irregular borders, color variation.

Chapter 8: Endocrinology

Pituitary Disorders

Prolactinoma: Amenorrhea, galactorrhea, treat with bromocriptine.
Diabetes Insipidus: Polyuria, polydipsia, hypernatremia.

Thyroid Disorders

Graves' Disease: Hyperthyroidism, diffuse goiter, exophthalmos.
Thyroid Nodule: Check TSH, FNA if indeterminate.

Adrenal Disorders

Cushing's Syndrome: Central obesity, hypertension, hyperglycemia.
Addison's Disease: Weakness, hypotension, hyperpigmentation.

Parathyroid Disease

Hyperparathyroidism: Kidney stones, constipation, psychiatric symptoms.
Hypoparathyroidism: Perioral numbness, Chvostek's sign.

Diabetes

DKA: Hyperglycemia, ketonemia, AGMA.
HHS: Hyperglycemia, hyperosmolarity, no ketosis.

Chapter 9: Neurology

Stroke

Ischemic: 80% of strokes, treat with tPA within 3-4.5 hours.
Hemorrhagic: Non-contrast CT to diagnose, manage BP.

Seizures

Partial: Focal onset, simple (no LOC) or complex (LOC).
Generalized: Grand mal, absence, myoclonic.

EEG Buzzwords

3 Hz Spike-and-Wave: Absence seizures.
Hypsarrhythmia: Infantile spasms.

Headache

Subarachnoid Hemorrhage: "Worst headache of life," non-contrast CT.
Migraine: Unilateral, throbbing, photophobia, phonophobia.

Neuromuscular Disorders

Guillain-Barré: Ascending paralysis, areflexia, treat with IVIG.
Myasthenia Gravis: Ptosis, diplopia, AchR antibodies.

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