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1
Q

manifestations of cerebellar dysfunction in alcohol abusers

A

gait instability, truncal ataxia, difficulty with rapidly alternating movements (dysdiadochokinesia), hypotonia, intention tremor

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2
Q

adjuvant vs salvage therapy

A

adjuvant is given in addition to (at same time) as standard therapy
salvage is given after if standard therapy fails
neoadjuvant is given before

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3
Q

drug of choice for stabilizing bony metastatic lesions to prevent hypercalcemia of malignancy and pathologic fractures

A

bisphosphonates (zoledronic acid, pamidronate)

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4
Q

PEP for Hepatitis B

A

Hep B IgG

if unvaccinated, Hep B IgG PLUS Hep B vaccine IMMEDIATELY

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5
Q

haldol or ativan for delirium in an demented elderly patient?

A

haldol

benzos are CI, may be metabolized slower, cause paradoxical agitation, and ^risk adverse events

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6
Q

how to treat UACS (upper airway cough syndrome)?

A

1st generation oral antihistamine (chlorpheniramine) or combined antihistamine-decongestant (brompheniramine and pseudo ephedrine)

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7
Q

most common early SEs of levodopa-carbidopa

A

*hallucinations, confusion, agitation, dizziness, somnolence, nausea
think added dopamine causes “schizophrenia-like” effects

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8
Q

what beta-1 agonist to use in decompensated heart failure? what effects does it have?

A

dobutamine: B-1 receptor agonist (some B-2 and a-1 activity)
positive inotrope: ^contractility, which DECREASES LVESV (less blood left in heart after contraction)
positive chronotrope: ^HR
minor B-2 activity leads to small DECREASED SVR

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9
Q

flu-like illness, symmetric polyarthralgias, macular rash on limbs/trunk, peripheral edema, cervical LAD after recent travel, think ?

A

Chikungunya fever

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10
Q

diabetic foot ulcer may cause what type of osteomyelitis (spread and # of organisms)?

A

polymicrobial infection via contiguous spread
S. aureus, S. progenies, Pseudomonas, anaerobes
tx with vanc and zosyn

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11
Q

initial treatment of PAD

A

smoking cessation, low-dose ASA, statin therapy, exercise program, eval for HTN/DM
next: cilostazol, then percutaneous or surgical revasculariztion if persistant symptoms
NOT warfarin

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12
Q

1st line treatment for idiopathic intracranial HTN

A

acetazolamide +/- furosemide

if refractory: optic nerve sheath decompression ro lumboperitoneal shunting

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13
Q

what to do if some AST/ALT elevation after beginning RIPE therapy?

A

nothing, common self-limiting reaction to INH

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14
Q

lab findings in polycythemia vera

A

^Hgb, ^WBC, ^plts
LOW EPO (normally activates JAK2 tyrosine kinase)
+JAK2 mutation (constitutively active, so down regulates EPO)
secondary forms of polycythemia will have ^EPO

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15
Q

how to tx PV

A

phlebotomy, hydroxyurea

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16
Q

manifestation of dermatomyositis

A 
weakness equal in UE and LE 
Gottron's papules (hands), heliotrope rash (face)
^CPK, aldolase, LDH
\+anti-RNP, anti-Jo-1, anti-Mi2
dx: EMG, skin/muscle bx
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17
Q

dermatomyositis is associated with ?

A

malignancy: ovarian, lung, pancreatic, stomach, CRC, non-Hodgkin lymphoma

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18
Q

antiemetics that can cause EPS

A

metoclopramide (reglan), prochlorperazine, promethazine (phenergan) (dopamine antagonist like antipsychotics)
decreased DA leads to relative ^ACh–>EPS
tx: anticholinergics like benadryl and benztropine
(zofran (ondansetron) is a serotonin antagonist)

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19
Q

best treatment for anorexia in cancer patients

A

progesterone analogues: megestrol acetate and medroxyprogesterone acetate
also corticosteroids, but these have more SEs
dronabinol: little benefit

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20
Q

vascular cutaneous lesion, fever, malaise, night seats, +/- liver, CNS, bonen involvement in HIV+ individual think?

A 
bacillary angiomatosis (if CD4+ less than 100)
Bartonella henselae: cat scratch
Bartonella quintana: lice bite
tx: doxy or erythromycin
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21
Q

tick bite + flu-like symptoms, anemia, thrombocytopenia, ^WBCs, ^bilirubin, ^LDH, ^LFTs, think ?
how to diagnose and treat?

A

Babesiosis
dx: thin blood smear, will see intraRBC rings (“Maltese cross”)
tx: atovaquone + azithromycin, quinine + clindamycin if severe
may cause DIC, CHF, ARDS, splenic rupture

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22
Q

tourniquet test used to diagnose ?

A

dengue fever
fever, severe mylagias/headache (“breakbone fever”)
low WBCs, low plts

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23
Q

important cause of hypocalcemia in alcoholics

A

hypomagnesemia

causes decreased release of PTH and PTH resistance (not association with ^phos like other causes of hypoPTH)

24
Q

pleural glucose less than 60 mg/dL or pleural fluid/serum glucose ration of less than 0.5 is seen in ?

A

complicate parapneumonic effusion, malignancy, TB, RA

other exudative and transudative effusion have pleural fluid glucose similar to blood glucose

25
pleural fluid pH in transudative and exudative effusions
normal: 7.60 transudative: 7.4-7.55 exudative: 7.30-7.45 if less than 7.30 usually due to ^acid production (empyema) or decreased H- efflux from pleural space (pleuritis, tumor, pleural fibrosis)
26
1st step if consider central retinal artery occlusion
ocular massage and high-flow O2 | intraarterial tPa within 4-6 hrs of vision loss MAY be useful
27
carpal tunnel treatment
1st: nocturnal wrist splinting | if unresponsive: oral or injected steroids, then surgical decompression
28
23- vs 13-valent pneumococcal vaccine immune responses
23: capsular polysaccharides, induces T-cell INDEPENDENT B-cell response 13: capsular polysaccharides conjugated to a protein antigen, T-cell DEPENDENT B-cell response (13 year olds are "dependent T-nagers")
29
Live vaccines such as MMR and intranasal influenza produce what immune response?
CD8+ T-cell proliferation
30
oral polio vaccine produces what response
IgA response (anti-poliovirus IgA antibodies into the GI tract)
31
Modified Well's
``` "SAT IS PBC" Signs (3) Alt. dx less likely (3) Tachy 100+ (1.5) Immobilization/Surgery (1.5) Previous PE/DVT (1.5) Blood (hemoptysis (1) Cancer (1) ``` greater than 4: PE likely : get CTA if less than 4: D-dimer
32
MTX SEs
GI symptoms, oral ulcers or stomatitis, rash, alopecia, hepatotoxicity, pulmonary toxicity, BM suppression supplement with folic acid (MTX is a purine antimetabolite)
33
TNF-a inhibitor (anti-cytokine) SEs
neutropenia, infection, demyelination, CHF, malignancy
34
INO is due to damage to ?
the heavily myelinated fibers of the medial longitudinal fasciculus (MLF) can occur with lacunar stroke in pontine artery distribution bilateral seen in MS
35
hypopigmented lesions with decreased sensitivity + painful nerve deformations and neuropathy think ? how to dx?
M. leprae | skin bx from edge of lesion
36
TB vs bacterial vs viral meningitis
bacterial: WBC 1000+, glucose less than 40, protein 250+ TB: 5-1000 WBC, glucose less than 10!, protein 250+ viral: 100-1000 WBC, glucose 40-70 (normal), protein less than 100
37
CSF in GBS
^protein with normal cell count (albuminocytologic dissociation)
38
fever, leukocytosis, LUQ abdominal pain, think? can also develop? what is it associated with? tx?
splenic abscess can develop L pleuritic chest pain, L pleural effusion, splenmeg associated with infectious endocarditis (hematogenous spread), IVDU, immunosuppression, trauma, Hgbpathies tx: splenectomy, perc. drainage if poor sx candidate
39
tight blood glucose control decreases what DM complications?
decreases MICROvascular complications: retinopahty, nephropathy uncertain effect on macro vascular (MI, stroke) and all-cause mortality
40
afib is most commonly caused by ectopic foci within ?
the pulmonary veins! | in contrast, ^SA node discharge rate causes sinus tach
41
a flutter commonly involves a ?
reentry circuit around the tricuspid annulus
42
who should be screened for hep C
IVDUsers, high-risk needle exposure, received blood transfusions before 1992
43
hyperthyroidism with RAIU scan showing uptake in 1 nodule/lobe
toxic adenoma with autonomous production of thyroid hormones in contrast, RAIU scan is dark if ^TH due to release of preformed TH and diffuse uptake seen if Graves (Ab-stimulated TH production)
44
plasma aldosterone/renin ratio suggestive of primary hyperaldosteronism
aldo/renin greater than 20 with plasma aldosterone greater than 15 ng/dL next: adrenal suppression with salt loading (+ is inability to suppress aldo) if +, abdominal CT to check out adrenals
45
best test for ddx adrenal adenoma and bilateral adrenal hyperplasia (if can't ddx on imaging)
adrenal venous sampling
46
LVEDV in CHF?
elevated due to increased blood volume due to renal sodium and water retention
47
drug-induced acne presents how? | due to what meds?
monomorphic papules/pustules, lack of comedones, atypical location/age meds: steroids, androgens, immunomodulators, anticonvulsants, antipsychs, antiTB (INH)
48
osteomalacia may be caused by ?
severe vit. D deficiency: malabsorption, bypass sx, celiac, chronic liver/kidney disease, RTA type 2, inadequate calcium intake
49
what lab results will be seen in osteomalacia?
low Ca2+ and phos absorption-->low levels | low Ca2+-->secondary hyperPTH-->^Ca2+ bone/kidney reabsorption-->^alk phos
50
osteomalacia on XR
decreased bone density with thinning cortex, "codfish" vertebral bodies (concave), pseudofx (Looser zones)
51
bone lesions due to malignancy are typically lytic and have what lab values
^Ca2+
52
bone mineralization and labs in osteoporosis
NORMAL mineralization NORMAL Ca2+, phos, PTH, alk phos! LOW bone mass
53
rapid-onset hirsutism in a female, think ? | how to work up?
hyperandrogenism (PCOS is slowly progressive) ^testosterone with normal DHEAS: ovarian source (more common) ^DHEAS: adrenal source
54
complications in ADPKD
``` liver cysts berry aneurysms valvular HD (MVP, AI) colonic diverticula abd. wall/inguinal hernia ```
55
ankylosing spondylitis pts can develop what lung disease? what PFTs?
restrictive LD due to decr. chest wall and spinal mobility decreased vital capacity and TLC but normal FEV1/FVC FRC and RV normal or increased
56
non-tender solitary LNs in head/neck are concerning for ?
squamous cell carcinoma
57
hold what meds before cardiac stress testing
BB, CCB, nitrates only IF pt does NOT have known CAD | continue if they do have CAD to determine efficacy of antianginal therapy

IM Uworld (16 decks)

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