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IM Uworld > 12 > Flashcards

12 Flashcards

1
Q

antibiotics for anaerobic coverage

A

metronidazole with amoxicillin, amoxicillin-clavulanate (augmentin), clindamycin

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2
Q

rapid cessation of steroid use may result in ?

A

central adrenal insufficiency

low ACTH, low cortisol, normal aldosterone (RAAS controlled)

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3
Q

how to interpret hazard ratio

A

hazard ratio less than 1 indicates an event is more likely to occur in the control group
greater than 1 more likely to occur in the treatment group

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4
Q

thyrotoxicosis with decreased RAIU

A 
painless (silent) thyroiditis
subacute (de Quervain) thyroiditis
amiodarone induced tyroiditis
excessive synthroid
struma ovarii
iodine-induced
thyroid cancer mets
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5
Q

painless (silent) thyroiditis vs de Quervain thyroiditis

A

painless: variant of Hashimoto (TPO Abs) but has hyperthyroid phase, may be tx with propranolol
de Quervain: painful, tender goiter, preceded by URI, tx with NSAIDs, prednisone

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6
Q

inflammatory arthritis, splenomegaly, neutropenia

A

Felty syndrome, common in RA pts

^risk vasculitis, skin ulcers

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7
Q

skin lesions in Hep C+ pt

A

porphyria cutanea tarda
other conditions assoc. with PCT: HIV, ^^etOH consumption, estrogen use, smoking
PCT tx: phlebotomy or hydroxychloroquine

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8
Q

features of mixed cryoglobulinemia

A

palpable purpura, arthralgias, GN

due to imm-complex deposition in small BVs, leading to endothelia injury and end-organ damage

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9
Q

heart manifestations of acromegaly

A

cardiomegaly, HTN, HF, mitral/aortic regurg

myocardial hypertrophy, diastolic dysfunciton, LF dilation, global hypokinesis

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10
Q

Pancoast tumor presentation

A

(superior pulmonary sulcus tumor)
shoulder pain*
Horner syndrome
C8-T2 neuro involvement (weakness/atrophy of intrinsic hand muscles, pain/paresth. of digits 4, 5, medial arm
supraclavicular LN enlargement, weight loss

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11
Q

also give ? with TMP-SMX in HIV+ pts with PCP if PaO2 less than 70 or A-a gradient more than 35

A

corticosteroids

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12
Q

incidentally discovered cystic hepatic lesion with eggshell calcification, think ?

A 
hydatid cyst (Echinococcus granulosus)
dogs are definitive hosts
tx: sx resection with albendazole, risk of anaphylactic shock with aspiration
in contrast, simple hepatic cysts do not have calcification
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13
Q

the probability of being free of a disease if the test is negative equals ?

A

the negative predictive value (NPV)
true negatives / all negatives
the NPV varies with pre test probability
if PTP is high, then NPV is LOW, if PTP is low, NPV is high

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14
Q

what organisms involved in a SINGLE brain abscess from direct extension from OM, sinusitis or dental infection

A

Viridans strep or S. aureus
s/s: Ha, fever, neuro deficits, seizure
single ring-enhancing lesion with central necrosis on imaging

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15
Q 
brain imaging:
Rhizopus
toxo
primary CNS neoplasm
Nocardia
HSV encephalitis
A

Rhizopus: highly destructive necrosis
Toxo: MULTIPLE ring-enhancing lesions
primary CNS neoplasm: SINGLE ring-enhancing lesion
Nocardia: brain abscess with ring-enhancing lesion
HSV encephalitis: hypodense lesions in temporal lobe (no ring enhancement)

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16
Q

situational syncope during micturition, defecation, cough is due to ?

A

alteration in autonomic response leading to cardioinhibitory, vasodepressor, or mixed response

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17
Q

medications that can trigger acute angle-closure glaucoma

A

decongestants, antiemetics, anticholinergic drugs

sympathetics ^pressure, B-blockers HELP

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18
Q

gold standard for acute angle-closure glaucoma diagnosis

A

gonioscopy

next is tonometry which measures IOP

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19
Q

lead vs arsenic poisoning

A

both may have stocking glove neuropathy
arsenic also has skin changes (hypo/hyperpigmentation), hyperkeratosis), pancytopenia, hepatitis (^AST, ALT)
lead typically has GI complaints

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20
Q

where do you get arsenic poisoning

how to treat

A

mining, pesticides, metalwork, working with antique pressure-treated wood preserved with arsenic
tx: chelation with demercaprol, DMSA

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21
Q

how to antihistamines (i.e. chlorpheniramine (H1)) alleviate cough symptoms?

A

exhibit anti-inflammatory effects by blocking histamine release from mast cells and limiting the secretory response to inflammatory cytokines

22
Q

skin infection with severe headache, bilateral periorbital edema, CN III, IV, V, VI deficits think ?

A

cavernous sinus thrombosis

may result from uncontrolled skin infection as the facial/opthalmic venous system is valveless

23
Q

why does BP rise in hyperthyroidism?

A

increase in heart rate and contractility

SVR typically decreases but BP still rises

24
Q

pt with pneumonia, hepatitis, gastroenteritis following solid organ transplant and no ppx, think ?

A

CMV
PCP would cause pneumonia but not other issues
ppx with TMP-SMX and valganciclovir

25
Q

most common skin malignancy in pts on chronic immunosuppressive therapy

A

squamous cell carcinoma

BCC most common overall

26
Q

CYP450 inhibitors (^warfarin’s effect)

A

acetaminophen, NSAIDs, abx/antifungals (metro), amiodarone
cimetidine (H2), cranberry juice
Ginkgo, vitamin E
Omeprazole, Thyroid hormone, SSRIs

27
Q

H1 vs H2 receptor blockers

A

H1: 1st generation: diphenhydramine (Benadryl)
2nd generation: loratadine (Claritin) and fexofenadine (Allegra) -less sedation
H2: found in stomach: famotidine (Pepcid) and ranitidine (Zantac)

28
Q

CYP450 Inducers (decrease warfarin’s effect)

A 
CRAP GPS induce me to madness!
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin

Griseofulvin, Ginseng
Phenobarbital, Pregnancy prevention (OCPs)
Sulphonylureas, St. John’s Wort

29
Q

CYP450 inhibitors (^warfarin’s effect) part II

A

Sodium Valproate
Isoniazid
Cimetidine (an H2 receptor blocker)
Ketoconazole & fluconazole

Fluoxetine
Alcohol - acute consumption & cigarettes
Cardiac failure and liver failure
Erythromycin & clarithromycin (macrolide antibiotics)
Sulphonamides (antibiotics)
.
Ciprofloxacin
Omeprazole (a proton-pump inhibitor)
Metronidazole (antibiotic effective against anaerobes)

30
Q

SOB and bibasilar crackles in pt with aortic dissection, think ?

A

aortic valve insufficiency
pericardial tamponade may occur with dissection but presents with hypotension, pulses paradoxes, ^JVP, cardiogenic shock with clear lung fields

31
Q

erysipelas caused by what organism?

A

S. pyogenes “Pyo Pelas”

32
Q

haptoglobin levels in hemolytic anemia

A

decreased
haptoglobin binds free Hgb, so more Hbg in serum exceeds binding ability of haptoglobin, so decreasing level of haptoglobin

33
Q

AMS, motor deficits, ataxia, with multiple non enhancing brain lesions with no mass effect (edema) on imaging in HIV+ pt with CD4 less than 200

A

Progressive multifocal leukoencephalopathy (JC virus reactivation)

34
Q

contralateral pure sensory loss +/- transient hemiparesis, athetosis, ballistic movements, think ?

A

lacunar stroke of posterolateral thalamus (branches of PCA) +/- thalamic pain syndrome later (allodynia)
disruptions of neighboring basal ganglia structures and corticospinal fibers in posterior limb of internal capsule

35
Q

major cause of delayed morbidity/mortality in SAH

how to prevent?

A

vasospasm, prevent with nimodipine

36
Q

if nonopioid analgesics are not effective for cancer-related pain, move on to ?

A

short-acting opioids

if requires frequent dosing or bedtime dose does not last through the night, add a long-acting opioid

37
Q

risk with fentanyl patches

A

respiratory depression, use only in opioid-tolerant pts

38
Q

stones less than ? typically pass spontaneously

A

5mm

39
Q

lithium toxicity, think ?

A

tremor, hyperreflexia, ataxia, seizures

40
Q

horizontal nystagmus, cerebellar ataxia, confusion, think OD with ?

A

phenytoin

41
Q

slurred speech, unsteady gait, drowsiness

BUT lack of severe respiratory depression and lack of pupillary constriction, think OD on ?

A

benzos

42
Q

neutropenic is PMNs less than

A

1500

43
Q

best treatment for chemo-induced n/v

A

serotonin (5HT) antagonists

zofran (ondansetron)

44
Q

most common adverse reaction occurring within 1-6 hours of blood transfusion

A

febrile nonhemolytic transfusion reaction
small amounts of residual plasma +/- leukocyte debris may remain in red cell concentrate which release cytokines in storage
may cause fever, chills, malaise, without hemolysis

45
Q

worrisome finding in acute asthma exacerbation

A

normal or elevated PaCO2 (should be low due to hyperventilation) implies impending respiratory failure

46
Q

how often to get mammograms

A

every 2 years from 50-74

47
Q

when to do lipid panel

A

men starting at 35, women at 45

every 5 years

48
Q

when to do pap smears

A

age 21-65 every 3 years

49
Q

thyroid storm may be triggered by

A

surgery, trauma, childbirth, infection, iodine load (CT scan)

50
Q

cardiac manifestations of sarcoidosis

A

infiltration of noncaseating granulomas leases to surrounding inflammation and can result in conduction defects (complete AV block*) restrictive or dilated cardiomyopathy, valvular dysfunction, HF
sudden cardiac death from complete AV block or ventricular arrhythmia

51
Q

concentric vs eccentric cardiac hypertrophy

A

concentric: chronic pressure overload (aortic stenosis or HTN)
eccentric: chronic volume overload (valve regurgitation)

IM Uworld (16 decks)

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