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IM Uworld > 1 > Flashcards

1 Flashcards

1
Q

how to tx uncomplicated cystitis

A 
TMP-SMX- 3ds
nitrofurantoin- 5ds
fosfomycin- 1x
FQs if cannot take above (sulfa allergy) or high resistance
*can tx without urine culture
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2
Q

what makes cystitis complicated

A

DM, CKD, immunocompromised, pregnant, urinary tract obstruction, hospital-acquired, infection with procedure, indwelling FB (cath)

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3
Q

how to tx complicated cystitis

A

get a urine culture
abx: FQs i.e. levofloxacin, cipro
may require ceftriaxone if more severe

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4
Q

if UA shows large blood but there is lack of RBCs on ur microscopy, think?

A

myoglobinuria from rhabdomyolysis

or hemoglobinuria

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5
Q

when to consider SIADH

A

hypotonic hyponatremia but euvolemia (water is reabsorbed)
low serum osm less than 275 (“dilute” blood)
high urine osm more than 100 (concentrating urine)
high urine sodium concentration more than 40 (losing salt)

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6
Q

membranoproliferative glomerulonephritis

A

dense intramembranous deposits that stain for C3 (type 2)
caused by IgG Abs (C3 nephritic factor) against C3 convertase of alternative complement pathway->persistent pathway activation and kidney damage

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7
Q

asterixis is seen in

A

hepatic encephalopathy, uremic encephalopathy, CO2 retention

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8
Q

indications for urgent dialysis

A

AEIOU
Acidosis, metabolic: refractory pH less than 7.1
E-lyte abnormalities: symp. hyperK (EKG change, V arrhyth) or severe refractory hyperK >6.5
Ingestion: tox. etOHs, salicylate, lithium, valproic acid, carbamazepine
Overload
Uremia: symptomatic: enceph, pericarditis, bleeding

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9
Q

meds that can induce crystal-induced AKI (renal tubular obstruction)

A

acyclovir, sulfa, MTX, ethylene glycol, protease inhibitors

*give fluid with drug

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10
Q

AIN usually occurs after ? days of drug exposure

A

7-10

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11
Q 
muddy brown granular casts
RBC casts
WBC casts
fatty casts
broad, waxy casts
A 
muddy brown granular casts -ATN
RBC casts -glomerulonephritis
WBC casts -interstitial nephritis, pyelo
fatty casts -nephrotic syndrome
broad, waxy casts -chronic renal failure
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12
Q

pathogenesis of uremic coagulopathy in chronic renal failure

what can be used to tx?

A

platelet dysfunction: plt-plt and pot-vessel wall interactions
i.e. aPTT, PT, and TT are normal, BT is prolonged
DDAVP (desmopressin): increases release of factor VIII: vW factor multimers from endothelium
also: cryoprecipitate, conj. estrogens

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13
Q

if albumin is decreased, how to correct calcium

A

normal albumin: 4, normal calcium: 10
therefore, if albumin is 3 (dec. by 1) calcium may measure at 9.2, but correct it by 0.8(each 1 pt reduction in albumin)
i.e. this would be 10

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14
Q

how to tx hypercalcemia

A

fluids, bisphosphonates, diuretics (inhibit calcium reabsorption)
maybe calcitonin if severe

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15
Q

when to get 1,25-vitamin D vs 25-vitamin D

A

get 1,25-vit D in granulomatous disease (i.e. sarcoidosis) and 25-vit D in vitamin D deficiency

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16
Q

symptoms of amyloidosis

A

proteinuria, nephrotic syndrome
restrictive cardiomyopathy, LVH (w/o hx of HTN)
anemia, GI bleed, early satiety
subQ nodules, enlarged tongue

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17
Q

mottled, cold LE, think?

A

acute limb ischemia from arterial occlusion
typically from cardiac emboli, thrombosis, or trauma
“livedo reticularis”

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18
Q

how to tx stable vs unstable Vtach

A

stable: IV amiodarone
unstable: synch. cardioversion

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19
Q

unstable Vtach

A

hypotension, signs of shock, AMS, resp. distress, persistent tachycardia, acute HF, pulmonary edema

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20
Q

how to ddx Vtach and SVT with aberrancy

both wide-complex tachycardias

A

presence of AV dissociation and fusion/capture beats supports Vtach

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21
Q

hypokalemia can potentiate to toxicity of what med

A

digoxin

22
Q

SEs of amiodarone

A

hypo/hyperthyroidism, hepatotoxicity, bradycardia/heart block, prolonged QT, torsades de pointes, interstitial pneumonitis, peripheral neuropathy, visual disturbances, hepatitis/transaminitis, blue-gray skin
*monitor LFTs and TFTs

23
Q

murmur of HOCM increases with?

A

LESS blood in heart (decreased preload)

i.e. valsalva, standing, nitro admin

24
Q

murmur of HCM decreases with?

A

MORE blood in heart (increased after load and/or increased preload)
i.e. hand grip, squatting, passive leg raise

25
Q

HCM inheritance

A

autosomal dominant

26
Q

use warfarin of NOACs in a fib if CHADSVASc score is ?

A

2+

27
Q

how does acute mitral regurgitation effect the heart?

A

elevated LA and LV filling pressures from volume overload and acute pulmonary edema

28
Q

how does chronic mitral regurgitation affect the heart?

A

increases LA and LV size and compliance

29
Q

ventricular free wall rupture usually occurs how long after MI?
presentation?

A

usually 5ds - 2wks, typically after anterior MI (LAD)

  • CP, shock, JVD, hemopericardium
  • pericardial effusion with tamponade
  • rapid progression to pulseless electrical activity
30
Q

other post-MI complications

A

RV failure: acute, RCA, Kussmaul sign (rise in JVP with inspiration)
Papillary muscle rupture: 3-5ds, RCA, pulmonary edema, severe mitral regurg
IV septum rupture/defect: 3-5ds, LAD/RCA, shock, CP, L–>R shunt

31
Q

first line tx for a fib 2/2 hyperthyroidism

A

B-blockers i.e. propranolol

controls HR and hyperadrenergic symptoms as well as decreasing conversion of T4–>T3 in peripheral tissues

32
Q

adenosine is used for ?

A

SVT with unclear dx (PSVT)

  • induces a transient bleck at the AV node
  • short duration
  • not for a fib, can be proarrhythmic
33
Q

1st line for paroxysmal a fib

A

amiodarone, flecanide

cardioversion (electrical or with ibutilide (corvert))

34
Q

used for rate control in afib

A

digoxin and CCBs (verapamil, diltiazem)

35
Q

drugs that can lead to long QT syndrome

A

diuretics, antiemetics (ondansetron-zofran), antipsychs, TCAs, SSRIs, antiarrythmics (amio, sot, flec), antianginal (ranolazine), anti-infectives (macros, antifungs, FQs)

36
Q

other causes of long QT

A

e- imbalances (low K, Mg, Ca), starvation, hypothyroidism, hypothermia, MI, intracranial disease, HIV
bradycardia: sinus node dysfunction, AV block

37
Q

treatment of torsardes

A

stable: IV magnesium sulfate
unstable: defibrillation

38
Q

what is atropine used for

A

symptomatic sinus bradycardia or AV nodal block

39
Q

defibrillation vs synchronized cardioversion for Vtach

A

defibrillation for pulseless Vtach or Vfib (more concerning)
synch. cardioversion for pts with hemodynamic instability for narrow or wide QRS complex tachy arrhyt. (a fib, aflutter, VT with pulse)

40
Q

other agents for Vfib

A

epinephrine every 3-5 min for persistent VF following defib and CPR
amiodarone or lidocaine if pulseless VT or VF unresponsive to defibrillation, CPR, epinephrine

41
Q

most common cause of sudden cardiac death during acute MI

A

VF

42
Q

treatment of choice for persistent tachyarrhythmias (i.e. AF with RVR) with clinical/hemodynamic instability (hypotension, cardiogenic shock, ischemia, acute HF)

A

synchronized cardioversion
vs unsynchronized shock (defibrilliation) indicated in VF/pulseless VT
-if stable consider adenosine, BB/CCB

43
Q

what used to reduce risk of thromboembolism in AF pts with mod-high CHADSVASc scores (2+)?

A

warfarin or non-vit K antagonist oral anticoags: apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto)
-better than anti platelet tx: ASA or clopidogrel (Plavix)

44
Q

what is cilostazol?

A

PDE inhibitor used for symptomatic management of intermittent claudication

45
Q

etiology of isolated systolic hypertension (>140 with diastolic <90)

A

increased stiffness/decreased elasticity of aortic/arterial walls (old ppl)

46
Q

cardiac manifest ions of Marfans

A

aortic regurgitation/dilation, aortic dissection, MVP

47
Q

what is pulses parvus et tardus

A

weak (parvus) and delayed (tarsus) pulse seen in severe aortic stenosis

48
Q

S3

A

normal in young adults

otherwise due to dilated ventricles from MVP resulting in regurgitation and HF

49
Q

coarctation may sometimes present in adulthood with ?

A

asymptomatic HTN in UEs, epistaxis, headaches
-proximal arterial pressure load, brachial-femoral pulse delay, systolic murmur thru constricted aorta, S4, rib notching, “3” sing on CXR

50
Q

digoxin toxicity presents with

A

fatigue, anorexia, nausea, blurred vision, disturbed color perception, cardiac arrhythmias

IM Uworld (16 decks)

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