FMGE Internal Medicine Flashcards

24 sample cards from the Internal Medicine deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. List the chronic microvascular and macrovascular complications of diabetes mellitus.

   Microvascular: retinopathy, nephropathy, and neuropathy. Macrovascular: coronary artery disease, stroke, and peripheral vascular disease. Also diabetic foot ulcers and increased infection risk.

2. What is the classic blood-film and lab picture of iron deficiency anemia?

   Microcytic hypochromic anemia (low MCV, low MCH) with low serum ferritin and serum iron, high TIBC, and low transferrin saturation; the most common cause of anemia worldwide.

3. What causes megaloblastic anemia and what are its hematologic hallmarks?

   Vitamin B12 or folate deficiency impairing DNA synthesis; macrocytic anemia (high MCV) with hypersegmented neutrophils and megaloblasts in the marrow. B12 deficiency may add neurological signs (subacute combined degeneration).

4. What laboratory findings indicate hemolytic anemia?

   Anemia with elevated reticulocyte count, raised indirect (unconjugated) bilirubin and LDH, low haptoglobin; peripheral smear may show schistocytes, spherocytes, or sickle cells. Direct Coombs test identifies autoimmune hemolysis.

5. What defines aplastic anemia and its characteristic finding?

   Bone marrow failure causing pancytopenia (anemia, leukopenia, thrombocytopenia) with a hypocellular ('empty', fatty) bone marrow and low reticulocyte count, without abnormal cells.

6. What is the empiric first-line antibiotic concept for community-acquired pneumonia and meningitis?

   CAP: amoxicillin or a macrolide (atypical cover); severe cases beta-lactam + macrolide. Bacterial meningitis: empiric ceftriaxone + vancomycin (add ampicillin if Listeria suspected) plus dexamethasone.

7. Name a classic viral infection cause for each: hepatitis transmitted enterally, mononucleosis, and dengue.

   Enterally transmitted hepatitis: Hepatitis A and E (fecal-oral). Infectious mononucleosis: Epstein-Barr virus (EBV). Dengue: dengue virus transmitted by Aedes aegypti mosquito.

8. What is the most common opportunistic fungal infection in immunocompromised/HIV patients and its treatment?

   Candidiasis (oral/esophageal) is common; Cryptococcus neoformans causes meningitis in advanced HIV (treated with amphotericin B + flucytosine then fluconazole). Invasive aspergillosis is treated with voriconazole.

9. What protozoan causes malaria, how is it diagnosed, and which species is most dangerous?

   Plasmodium species transmitted by female Anopheles mosquito; diagnosed by peripheral blood smear (thick and thin films) or rapid antigen test. Plasmodium falciparum causes the most severe/cerebral malaria.

10. What is the principle of empiric vs definitive (de-escalation) antimicrobial therapy?

    Empiric therapy is broad-spectrum, started before culture results based on likely pathogens; once culture and sensitivity return, therapy is de-escalated (narrowed) to the most effective, narrowest-spectrum agent (antimicrobial stewardship).

11. What are the diagnostic hallmarks (clinical and serologic) of rheumatoid arthritis?

    Symmetric inflammatory polyarthritis of small joints (MCP, PIP, wrist) with morning stiffness >1 hour, sparing the DIP joints; positive rheumatoid factor and anti-CCP antibodies, with raised ESR/CRP and erosions on X-ray.

12. What are the characteristic features and key autoantibodies of systemic lupus erythematosus (SLE)?

    Multisystem disease with malar (butterfly) rash, photosensitivity, arthritis, serositis, nephritis, and cytopenias. ANA is sensitive (screening); anti-dsDNA and anti-Smith antibodies are specific. Affects mainly young women.

13. What unifies the spondyloarthropathies, and which gene is associated?

    Seronegative (RF-negative) inflammatory arthritides involving the axial skeleton/sacroiliitis and enthesitis, strongly associated with HLA-B27. They include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and enteropathic arthritis.

14. How are vasculitides classified by vessel size, with one example of each?

    Large vessel: giant cell (temporal) arteritis, Takayasu arteritis. Medium vessel: polyarteritis nodosa, Kawasaki disease. Small vessel: granulomatosis with polyangiitis (ANCA-associated), Henoch-Schonlein purpura (IgA vasculitis).

15. What are the classic 'geriatric giants' (geriatric syndromes)?

    The geriatric giants include immobility, instability (falls), incontinence, and impaired cognition/intellect (delirium and dementia); also frailty, pressure ulcers, and iatrogenesis.

16. What is polypharmacy and why is it a concern in the elderly?

    Polypharmacy is the concurrent use of multiple medications (commonly >=5); in the elderly it increases the risk of adverse drug reactions, drug-drug interactions, falls, non-adherence, and prescribing cascades. Tools like the Beers criteria identify potentially inappropriate medications.

17. What is a comprehensive geriatric assessment (CGA)?

    A multidimensional, interdisciplinary evaluation of an older adult's medical, functional (ADL/IADL), cognitive, psychological, nutritional, and social status to develop a coordinated care and follow-up plan.

18. Name key live-attenuated vaccines that are part of childhood immunization and a contraindication.

    Live vaccines include BCG, oral polio (OPV), measles/MMR, rotavirus, and varicella. They are generally contraindicated in pregnancy and in significant immunocompromise.

19. Which adult vaccinations are routinely recommended, especially for older or high-risk adults?

    Annual influenza vaccine, pneumococcal vaccine (e.g., for age >=65 or chronic disease), tetanus-diphtheria (Td/Tdap) boosters, herpes zoster (shingles) vaccine for older adults, and COVID-19; hepatitis B for at-risk groups.

20. Which vaccines are commonly required or recommended for international travelers?

    Depending on destination: yellow fever (mandatory for some countries, with certificate), typhoid, hepatitis A and B, meningococcal (e.g., for Hajj), Japanese encephalitis, rabies (pre-exposure), and cholera; plus malaria chemoprophylaxis (not a vaccine).

21. What ECG leads localize an inferior wall myocardial infarction, and which artery is usually involved?

    Inferior MI shows ST elevation in leads II, III, and aVF, usually due to occlusion of the right coronary artery (RCA). It may be complicated by bradycardia/heart block and right ventricular involvement.

22. What is the most common organism causing spontaneous bacterial peritonitis (SBP) and its diagnostic ascitic fluid criterion?

    E. coli is the most common cause. Diagnosis: ascitic fluid polymorphonuclear (neutrophil) count >=250 cells/mm3; treated empirically with a third-generation cephalosporin (e.g., cefotaxime).

23. What is the formula and significance of the corrected reticulocyte count / anemia classification by MCV?

    Anemia is classified by MCV as microcytic (<80 fL: iron deficiency, thalassemia), normocytic (80-100 fL: acute blood loss, hemolysis, chronic disease), and macrocytic (>100 fL: B12/folate deficiency). A reticulocyte response indicates marrow activity (hemolysis/blood loss vs hypoproliferative anemia).

24. What is the Wells/CURB-65 type concept—name the CURB-65 criteria used to assess pneumonia severity.

    CURB-65: Confusion, Urea >7 mmol/L, Respiratory rate >=30, Blood pressure (systolic <90 or diastolic <=60), and age >=65. Each scores 1 point; higher scores indicate greater severity and need for hospital/ICU admission.

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