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IM Uworld > 11 > Flashcards

11 Flashcards

1
Q

what can increase risk of digoxin toxicity?

A

viral illness, excessive diuretic use (esp. loop), hypokalemia
volume depletion or renal injury may acute elevate the digoxin level

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2
Q

dig tox SEs

A

n/v, decreased appetite, confusion, weakness, diarrhea, scotomata, blurry vision with color changes, blindness

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3
Q

in case-control studies, when is the odds ratio a close approximation of the relative risk?

A

if the outcome is uncommon in the population (“rare disease assumption”)

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4
Q

pheos can be precipitated by

A

^intra-abdominal pressure, sx procedures, meds (anesthetic agents)

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5
Q

cellulitis vs erysipelas

A

cellulitis: deep dermis and subQ fat with flat, indistinct borders (S. pyogenes or S. aureus)
erysipelas: epidermis and superficial dermis with raised sharp borders and intense erythema (S. pyogenes)

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6
Q

erythema nodosum is associated with ?

A

S. pharyngitis, sarcoidosis, IBD

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7
Q

what is found in the anterior mediastinum?
middle?
posterior?

A

anterior: thymoma
middle: bronchogenic cysts
posterior: neurogenic tumors

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8
Q

PCOS treatment to regulate menstruation

other treatments

A

OCPs for menstrual regulation
Clomiphene citrate for ovulation induction
spironolactone for control of hirsutism
(weight loss is 1st line)
(leuprolide is for endometriosis, not PCOS)

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9
Q

how does lymphoma result in ^Ca2+?

A

^1,25-OH vitamin D leads to ^Ca2+ absorption

PTH will be low, vitamin D is elevated

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10
Q

most common cause of early decrescendo diastolic murmur in y. adults in developed countries

A

bicuspid aortic valve

this is aortic regurgitation

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11
Q

sharp, localized pain and tenderness over the anteromedial part of the tibial plateau

A

pes anserinus pain syndrome

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12
Q

ratio in ARDS

A

P/F: PaO2/FiO2 is decreased (less than 300 mmHg)

partial pressure of arterial O2 decreases and leads to an increased fraction of inspired O2 requirement

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13
Q

histoplasmosis vs coccidiodomycosis lung presentation

A

histo: bilateral infiltrates with granulomas on biopsy
coccid: unilateral infiltrate with spherules with endospores on biopsy

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14
Q

pyelonephritis with urine pH greater than 8 think ?

A

urease producing bacteria: most commonly Proteus, also Klebsiella

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15
Q

rare but dangerous complications of infectious mono

A

airway compromise, autoimmune hemolytic anemia and thrombocytopenia
due to cross-reactivity of EBV-induced Abs against RBCs and plots
+Coombs, ^retic count, ^bilirubin, ^transaminases

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16
Q

if test result is negative, the probability of having disease is ?

A

1 - NPV

NPV = true negative results / all negative results

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17
Q

dilutional hyponatremia with NS?

A

free water content in NS is not high enough to cause significant dilution hyponatremia in absence of SIADH

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18
Q

hypokalemia EKG

A

U waves, flat, broad T waves, PVCs

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19
Q

two sample t-test vs chi-square test

A

chi-square compare proportions, or categorical values (i.e. “high CRP” vs. numerical values)
two sample t- and z- tests are used to compare 2 means
ANOVA compares 3+ means
meta-analysis pools data from several studies to do an analysis of having a relatively big statistical power

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20
Q

leukoplakia vs squamous cell carcinoma

A

leukoplakia: white granular lesions
sqcc: nodular, erosive, ulcerative lesions with surrounding erythema or induration
both cannot be scraped off

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21
Q

1st line therapy for stable angina with ASA and nitrates (decrease preload)

A

B-blockers to decrease myocardial contractility and O2 demand
CCBs as alternatives, dihyro. CCBs additional to BB for after load reduction
ranolazine (decrease myocardial Ca2+ influx) for refractory angina

22
Q

melanocyte disorders

A

peibaldism: AD, patchy absence of melanocytes
vitiligo: regional destruction of melanocytes (autoimmune)

23
Q

acute decomp. HF tx

A

supplemental O2, assisted ventilation, aggressive IV diuresis, +/- vasodilator therapy (nitro)

24
Q

RA pts are at ^risk of developing what bone condition?

A

osteoporosis, osteopenia, fractures

25
Q

another name for paget disease of bone

A

osteitis deformans

26
Q

tx for CML is a ? inhibitor

A

imatinib, tyrosine kinase inhibitor

27
Q

carcinoid syndrome may result in deficiency of what vitamin

A

niacin

^production of serotonin from tryptophan (required for niacin synthesis)

28
Q

50+ with pain/stiffness in neck, shoulders, pelvis

^ESR, think ?

A

polymyalgia rheumatica, tx with low-dose prednisone

29
Q

primary treatment for papillary thyroid carcinoma

A

surgical resection

if increased risk recurrence: radio iodine ablation + suppressive doses of thyroid hormone

30
Q

Leydig cell tumors will show an elevation in ?

A

testosterone +/- estrogen (^aromatase expression)
secondary inhibition of FSH, LH
most common type of testicular sex cord stromal tumors

31
Q

seminomas have elevation of what tumor markers?

A

NONE, usually normal, possibly B-hCG if contain syncytiotrophoblastic giant cells
yolk salk: ^AFP
choriocarcinoma: ^hCG

32
Q

most common cause of sudden cardiac arrest in the immediate post-infarction period

A

reentrant ventricular arrhythmias (v tach, v fib*)

AV block may occur with acute MI (esp. inferior) but typically transient and resolve after tPa or PCI

33
Q

B-cell vs non B-cell tumor

A

both may produce hypoglycemia
B-cell (insulinoma): ^insulin, ^C-peptide, ^proinsulin levels
non B-cell (mesenchymal tumors, produce IGF-II): low insulin and C-peptide

34
Q

why may hypocalcemia develop after blood transfusion?

why may hyperkalemia develop?

A

^plasma citrate (substance added to stored blood) chelates calcium and Mg+ and reduces levels

stored RBCs lose intracellular K+ to solution–>K+

35
Q

if trigeminal neuralgia presents bilaterally, suspect ?

A

MS

demyelination of the nucleus of the trigeminal nerve

36
Q

osteomalacia is commonly due to ?

what levels of Ca2+, phos, PTH?

A

commonly due to vit D deficiency: malabsorption, CKD
decreased absorption of Ca2+ and phos, reflexively ^PTH, so low/normal Ca2+ and very low phos
features: thinning cortex, codfish vertebrae, pseudofx

37
Q

acute blood surrounding brainstem and basal cisterns on noncontrast head CT

A

SAH, if non traumatic most commonly from ruptured berry aneurysm
HTN encephalopathy will NOT show acute hemorrhage!

38
Q

gout, hepatosplenomegaly, pruritus after shower, think ?

A

myeloproliferative disorder

overproduction of uric acid: gout

39
Q

cryptococcus meningitis typically seen in HIV pts with CD4 less than ?
CMV retinitis?

A

100

less than 50

40
Q

how do nitrates reduce angina?

A

systemic vasodilation leads to decrease in LV EDV (less blood into LV) and reduced wall stress resulting in less myocardial O2 demand

41
Q

lipoma vs epidermal inclusion cyst

A

lipoma dose not regress/recur
epidermal inclusion cysts have a small central punctum, may gradually increase in size, +/- produce a discharge; typically resolves spontaneously

42
Q

acute, severe unilateral periorbital pain with ipsilateral mitosis and/or lacrimation, think ?
how to treat?

A

cluster headache

tx with 100% O2, subQ sumatriptan

43
Q

pts who receive solid organ transplantation and are on immunosuppressants should receive ppx for what?

A

PCP pneumonia: TMP-SMX!!!

vaccines for pneumococci and hep B prior to transplant, intranasal influenza yearly
+/- ppx for CMV: ganciclovier, valganciclovier

44
Q

severe ear pain, fever, ^ESR, granulation tissue in ear canal, think ? and treat with ?

A

malignant (necrotizing) otitis externs caused by Pseudomonas (old ppl, DM, immunosuppressed)
tx with IV ciprofloxacin

45
Q

metabolic abnormalities in hypothyroidism

A

hyperlipidemia, hyponatremia, ^CK, ^AST, ALT

46
Q

causes of “steppage” gait

A

L5 radiculopathy and compression peroneal neuropathy

L5 will also have weak foot inversion and plantar flexion

47
Q

painful, acute retinal necrosis + keratitis, uveitis in HIV+ pt

A

HSV or VSV retinitis
CMV retinitis is painless, not associated with keratitis or conjunctivitis and has hemorrhages, fluffy/granular lesions around retinal vessels

48
Q

progressive bilateral loss of central vision

A

macular degeneration

49
Q

1st degree AV block treatment

A

if normal QRS duration: observation

if prolonged QRS: may have conduction delay below AV nod and should have electrophysiology testing

50
Q

post-op pt with hypotension, JVD, and new-onset RBBB

A

massive PE

IM Uworld (16 decks)

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