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Internal Medicine COMAT Review TEST |Q&A’s Latest Update| Verified
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Internal Medicine COMAT Review TEST |Q&A’s Latest Update| Verified
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Internal Medicine COMAT Review TEST|Q&A’s Latest Update| Verified
What is neutropenic fever - ✔✔Neutropenic fever= temperature greater than 38.3 C (101 F)
& an absolute neutrophil count less than 500.
What antibiotics are appropriate for patients with neutropenic fever? - ✔✔Antibiotics used
in neutropenic fever need to treat for pseudomonas (since it can be lethal in septic patients if
left untreated)--> ceftazadime, cefepime, piperacillin-tazobactam, meropenem, imipenem.
For persistent neutropenic fevers, after giving broad spectrum antibiotics that cover for
pseudomonas, what should be added? - ✔✔For persistenet neutropenic fevers, add a broad
spectrum anti-fungal agent (like amphotericin B).
Centor Criteria for Strep Throat - ✔✔4 criteria= fever, tonsillar exudates, tender anterior
cervical lymphadenopathy, absence of cough.
Score of 0/1= no test.
Score of 2= RADT (rapid antigen detection test)
Score of 3/4= not test.
Score of 0/1= no treatment
Score of 2= Penicillin V if positive RADT
Score of 3/4= Emperic Penicillin V
Causes of orthostatic hypotension - ✔✔Causes of orthostatic hypotension can include
medications, hypovolemia, cardiac insufficiency, and diabetic neuropathy.
,vesicular breath sounds - ✔✔Normal breath sounds in the lung, characterized by a long
inspiratory phase followed by a short expiratory phase
Bronchial breath sounds - ✔✔Compared to vesicular breath sounds, bronchial breath sounds
have a louder, shorter inspiratory phase and louder, prolonged expiratory phase. This is a
normal finding when heard over the trachea. However, when bronchial breath sounds are
heard in a location other than the trachea, it is suggestive of pulmonary consolidation (meaning
the alveoli are full of something other than air such as pus, water, or blood).
What do you do if you hear decreased breath sounds upon auscultation? - ✔✔When you
hear decreased breath sounds, percuss out the lungs.
Dullness to percussion in an area of decreased breath sounds suggests pleural effusion,
whereas hyperresonance suggests pneumothorax.
Criteria used to decide whether to admit patients with community-acquired pneumonia -
✔✔PORT (pneumonia severity index score) & CURB-65:
C=confusion
U=blood Urea nitrogen >19
R=Respiratory rate (>30 breaths/minute)
B=Blood Pressure (systolic <90 or diastolic <60)
age>65
w/CURB-65, consider hospitalization w/score of 1/2; urgent hospitalization if score score 3-4
Bloody lumbar puncture is associated with... - ✔✔Subarachnoid hemorrhage & herpes
encephalopathy.
Common associations w/Waterhouse-Friderichsen syndrome (hemorrhage of adrenal glands &
septic shock from N meningitidis) - ✔✔DIC & petechial rash.
,Common presentation of acute lymphoblastic leukemia (ALL) - ✔✔Presents in a younger
child (2-5 years old) with fever (due to neutropenia), pallor & fatigue due to anemia, &
petechiae (due to thrombocytopenia).
What's a major differentiating factor between TTP/HUS and DIC? - ✔✔DIC is associated with
an increase in both PT and PTT (not TTP/HUS), and bleeding usually occurs at venipuncture
sites.
What are some differentiating factors btwn TTP and HUS - ✔✔HUS is often associated with a
prodromal bloody diarrhea
TTP often is associated with neurological deficits
Characteristics common to both TTP and HUS - ✔✔Fever, anemia, & acute renal failure.
Both can present with elevated LDH, indirect bilirubin, and schistocytes on peripheral smear
(consistent with MAHA- microangiopathic hemolytic anemia).
Hallmark metabolic disturbance of refeeding syndrome - ✔✔Hypophosphatemia
Best 1st test when a patient comes in w/chest pain - ✔✔EKG
Changes in EKG suggesting a STEMI - ✔✔ST elevation 2mm or new LBBB
Anterior infarct - ✔✔LAD
Leads V1-4
Lateral infarct - ✔✔Circumflex artery
Leads I, aVL, V4-6
, Inferior infarct - ✔✔Right coronary artery
Leads II, III, & aVF
Right ventricular infarct - ✔✔Right coronary artery
Leads--> V4 on R-sided EKG= 100% specific
Symptoms of right ventricular infarct - ✔✔Hypotension, tachycardia, clear lungs, JVD, and
NO pulsus paradoxus...
DON'T give nitro!!
Treatment of right ventricular infarct - ✔✔Vigorous fluid resuscitation.
Next best test in chest pain patient after EKG - ✔✔Cardiac enzymes... (Myoglobin, CKMB,
troponin I)
if elevated--> NSTEMI!! (check enzymes q 8hrs X3)
First cardiac enzyme to elevate in an NSTEMI - ✔✔myoglobin (peaks in 2 hrs, normal by 24
hrs). **that's why this is the best biomarker to use to see if there's a repeat STEMI
Which cardiac enzyme lasts the longest in blood strem - ✔✔Troponin I
Treatment of a STEMI - ✔✔emergency reperfusion- go to cath lab or thrombolytics if no
contraindications
Treatment of NSTEMI - ✔✔MONA-B
Morphine
Oxygen
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