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IM Uworld > 10 > Flashcards

10 Flashcards

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
Q

pleural fluid pH in transudative and exudative effusions

A

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
Q

1st step if consider central retinal artery occlusion

A

ocular massage and high-flow O2

intraarterial tPa within 4-6 hrs of vision loss MAY be useful

27
Q

carpal tunnel treatment

A

1st: nocturnal wrist splinting

if unresponsive: oral or injected steroids, then surgical decompression

28
Q

23- vs 13-valent pneumococcal vaccine immune responses

A

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
Q

Live vaccines such as MMR and intranasal influenza produce what immune response?

A

CD8+ T-cell proliferation

30
Q

oral polio vaccine produces what response

A

IgA response (anti-poliovirus IgA antibodies into the GI tract)

31
Q

Modified Well’s

A 
"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
Q

MTX SEs

A

GI symptoms, oral ulcers or stomatitis, rash, alopecia, hepatotoxicity, pulmonary toxicity, BM suppression
supplement with folic acid (MTX is a purine antimetabolite)

33
Q

TNF-a inhibitor (anti-cytokine) SEs

A

neutropenia, infection, demyelination, CHF, malignancy

34
Q

INO is due to damage to ?

A

the heavily myelinated fibers of the medial longitudinal fasciculus (MLF)
can occur with lacunar stroke in pontine artery distribution
bilateral seen in MS

35
Q

hypopigmented lesions with decreased sensitivity + painful nerve deformations and neuropathy think ?
how to dx?

A

M. leprae

skin bx from edge of lesion

36
Q

TB vs bacterial vs viral meningitis

A

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
Q

CSF in GBS

A

^protein with normal cell count (albuminocytologic dissociation)

38
Q

fever, leukocytosis, LUQ abdominal pain, think?
can also develop?
what is it associated with?
tx?

A

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
Q

tight blood glucose control decreases what DM complications?

A

decreases MICROvascular complications: retinopahty, nephropathy
uncertain effect on macro vascular (MI, stroke) and all-cause mortality

40
Q

afib is most commonly caused by ectopic foci within ?

A

the pulmonary veins!

in contrast, ^SA node discharge rate causes sinus tach

41
Q

a flutter commonly involves a ?

A

reentry circuit around the tricuspid annulus

42
Q

who should be screened for hep C

A

IVDUsers, high-risk needle exposure, received blood transfusions before 1992

43
Q

hyperthyroidism with RAIU scan showing uptake in 1 nodule/lobe

A

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
Q

plasma aldosterone/renin ratio suggestive of primary hyperaldosteronism

A

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
Q

best test for ddx adrenal adenoma and bilateral adrenal hyperplasia (if can’t ddx on imaging)

A

adrenal venous sampling

46
Q

LVEDV in CHF?

A

elevated due to increased blood volume due to renal sodium and water retention

47
Q

drug-induced acne presents how?

due to what meds?

A

monomorphic papules/pustules, lack of comedones, atypical location/age
meds: steroids, androgens, immunomodulators, anticonvulsants, antipsychs, antiTB (INH)

48
Q

osteomalacia may be caused by ?

A

severe vit. D deficiency: malabsorption, bypass sx, celiac, chronic liver/kidney disease, RTA type 2, inadequate calcium intake

49
Q

what lab results will be seen in osteomalacia?

A

low Ca2+ and phos absorption–>low levels

low Ca2+–>secondary hyperPTH–>^Ca2+ bone/kidney reabsorption–>^alk phos

50
Q

osteomalacia on XR

A

decreased bone density with thinning cortex, “codfish” vertebral bodies (concave), pseudofx (Looser zones)

51
Q

bone lesions due to malignancy are typically lytic and have what lab values

A

^Ca2+

52
Q

bone mineralization and labs in osteoporosis

A

NORMAL mineralization
NORMAL Ca2+, phos, PTH, alk phos!
LOW bone mass

53
Q

rapid-onset hirsutism in a female, think ?

how to work up?

A

hyperandrogenism (PCOS is slowly progressive)
^testosterone with normal DHEAS: ovarian source (more common)
^DHEAS: adrenal source

54
Q

complications in ADPKD

A 
liver cysts
berry aneurysms
valvular HD (MVP, AI)
colonic diverticula
abd. wall/inguinal hernia
55
Q

ankylosing spondylitis pts can develop what lung disease? what PFTs?

A

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
Q

non-tender solitary LNs in head/neck are concerning for ?

A

squamous cell carcinoma

57
Q

hold what meds before cardiac stress testing

A

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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