INI CET 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. What are the main microvascular and macrovascular complications of diabetes?

   Microvascular: retinopathy, nephropathy (microalbuminuria progressing to proteinuria), and neuropathy (distal symmetric polyneuropathy, autonomic). Macrovascular: coronary artery disease, stroke, and peripheral arterial disease.

2. What are the laboratory findings of iron deficiency anemia?

   Microcytic, hypochromic anemia (low MCV, low MCH) with low serum ferritin (most specific), low serum iron, high total iron-binding capacity (TIBC), low transferrin saturation, and high RDW. Most common cause of anemia worldwide.

3. What distinguishes the two main causes of megaloblastic anemia (B12 vs folate deficiency)?

   Both cause macrocytic anemia with hypersegmented neutrophils and elevated homocysteine. B12 deficiency also raises methylmalonic acid (MMA) and causes neurologic deficits (subacute combined degeneration); folate deficiency has normal MMA and no neurologic findings.

4. What lab findings indicate hemolytic anemia?

   Elevated indirect (unconjugated) bilirubin, elevated LDH, low haptoglobin, and reticulocytosis. Direct Coombs (DAT) positive in autoimmune hemolysis; schistocytes suggest microangiopathic hemolysis; spherocytes suggest hereditary spherocytosis or warm AIHA.

5. What is the characteristic bone marrow and blood picture of aplastic anemia?

   Pancytopenia (anemia, leukopenia, thrombocytopenia) with reticulocytopenia and a hypocellular ('empty,' fat-replaced) bone marrow on biopsy. Causes include idiopathic/autoimmune, drugs, radiation, viruses, and benzene exposure.

6. Name a classic bacterial infection example for each: gram-positive cocci, gram-negative rod, and an intracellular bacterium.

   Gram-positive cocci: Staphylococcus aureus (clusters), Streptococcus (chains). Gram-negative rod: Escherichia coli. Obligate intracellular: Mycobacterium tuberculosis (acid-fast), Chlamydia, Rickettsia.

7. What are the classic clinical-lab features distinguishing common viral hepatitis transmission routes?

   Hepatitis A and E: fecal-oral, acute self-limited (E dangerous in pregnancy). Hepatitis B, C, D: bloodborne/sexual, can become chronic. Hepatitis D requires co-infection with B (needs HBsAg envelope).

8. What is the most common opportunistic fungal infection in AIDS patients with low CD4, and a key invasive mold in neutropenic patients?

   Pneumocystis jirovecii pneumonia (PJP) occurs with CD4 less than 200 (treat/prophylax with TMP-SMX). Aspergillus is the key invasive mold in prolonged neutropenia (galactomannan, halo sign on CT).

9. Name the parasitic cause and diagnostic hallmark of malaria.

   Plasmodium species (P. falciparum most severe), transmitted by female Anopheles mosquito. Diagnosis: thick and thin blood smears (gold standard) or rapid antigen tests; ring forms and banana-shaped gametocytes suggest P. falciparum.

10. What are the four mechanisms of antibiotic resistance?

    Enzymatic inactivation (e.g., beta-lactamases), altered target site (e.g., altered PBPs in MRSA, ribosomal mutations), decreased drug uptake/porin loss, and increased efflux pumps.

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

    Empiric therapy is broad-spectrum, started before culture results based on likely pathogens and local resistance. Definitive therapy narrows coverage (de-escalation) once culture and sensitivities identify the organism, reducing resistance and toxicity.

12. What are the 2010 ACR classification criteria components and key serologies for rheumatoid arthritis?

    Criteria weigh joint involvement (small joints, symmetric), serology (RF and anti-CCP/ACPA), acute-phase reactants (ESR/CRP), and symptom duration greater than 6 weeks. Anti-CCP is most specific. Classic: symmetric small-joint polyarthritis with morning stiffness greater than 1 hour.

13. What antibody is most sensitive and what antibodies are most specific for systemic lupus erythematosus (SLE)?

    ANA is most sensitive (screening; near 100% sensitive but not specific). Anti-dsDNA (correlates with disease activity/nephritis) and anti-Smith are most specific for SLE.

14. What defines the seronegative spondyloarthropathies and their shared genetic marker?

    A group including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and IBD-associated arthritis. They are RF-negative, associated with HLA-B27, and feature axial/sacroiliac involvement, enthesitis, dactylitis, and asymmetric oligoarthritis.

15. 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 (c-ANCA), microscopic polyangiitis, eosinophilic granulomatosis (Churg-Strauss), IgA vasculitis (HSP).

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

    Multifactorial conditions common in the elderly: immobility, instability (falls), incontinence, and impaired cognition/intellect (delirium and dementia). Often expanded to include frailty, pressure ulcers, and polypharmacy.

17. What is polypharmacy, and which tools help reduce inappropriate prescribing in the elderly?

    Polypharmacy is the concurrent use of multiple medications (commonly defined as 5 or more), increasing risk of adverse drug events and interactions. The Beers Criteria and STOPP/START criteria identify potentially inappropriate medications to deprescribe.

18. What domains are assessed in a Comprehensive Geriatric Assessment (CGA)?

    A multidimensional evaluation of medical (comorbidities, medications, nutrition), functional (ADLs/IADLs, gait/balance), cognitive/psychological (cognition, mood), and social/environmental status, to create a coordinated care plan.

19. What is the typical childhood vaccination schedule highlight for measles and DTaP?

    MMR (measles-mumps-rubella) is given as a 2-dose series, first at 12-15 months and second at 4-6 years. DTaP (diphtheria-tetanus-acellular pertussis) is a 5-dose primary series at 2, 4, 6, and 15-18 months, and 4-6 years.

20. Which vaccines are routinely recommended for adults aged 65 and older?

    Annual influenza vaccine, pneumococcal vaccines (PCV and/or PPSV23), recombinant zoster (shingles) vaccine (2 doses), and Tdap once then Td/Tdap booster every 10 years. RSV vaccine is also recommended for older adults.

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

    Depending on destination: hepatitis A and B, typhoid, yellow fever (required for some African/South American countries with certificate), Japanese encephalitis, rabies (pre-exposure), meningococcal (required for Hajj), and cholera. Ensure routine vaccines are up to date.

22. What is a live attenuated vaccine and which key patient groups should avoid it?

    A live attenuated vaccine (e.g., MMR, varicella, yellow fever, oral polio, BCG, intranasal influenza) contains weakened but replicating organisms. It is contraindicated in pregnant women and significantly immunocompromised patients due to risk of disease from the vaccine strain.

23. What are the typical clinical features (symptoms) of acute kidney injury?

    Often asymptomatic early; may show decreased urine output (oliguria/anuria), fluid overload (edema, pulmonary congestion), and symptoms of uremia (nausea, fatigue, confusion, asterixis, pericardial rub) and electrolyte disturbances (hyperkalemia causing arrhythmias).

24. What is the classic presentation of acute coronary syndrome, including atypical presentations?

    Classic: crushing substernal chest pressure radiating to the left arm or jaw, with diaphoresis, dyspnea, and nausea, lasting greater than 20 minutes and not relieved by rest. Atypical (women, elderly, diabetics): dyspnea, epigastric pain, fatigue, or silent ischemia.

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