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IM Uworld > 3 > Flashcards

3 Flashcards

1
Q

TIAs in the carotid system can cause ?

A

temporary loss of speech, paralysis/paresthesias of C/L extremity, clumsiness of 1 limb, amaurosis fugax: transient loss of sight in I/L eye due to micro emboli to retina

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2
Q

TIAs in the vertebrobasilar system can cause ?

A

decreased perfusion to posterior fossa, dizziness, double vision, vertigo, numbness of I/L face and C/L limbs, dysarthria, horsiness, dysphagia, projectile vomiting, HA, drop attacks

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3
Q

subclavian steal syndrome

A

stenosis of subclavian artery proximal to vertebral artery origin such that when working out left arm, distal subclavian artery “steals” blood from vertebral artery resulting in decreased cerebral blood flow resulting in symptoms in previous card

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4
Q

if block in MCA

A

C/L hemiparesis, sensory loss, hyperreflexia (UE more than LE)
aphasia (if dom hemisphere) apraxia (if nondom)

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5
Q

lacunar stroke symptoms based on location

A

internal capsule -motor
thalamus -sensory
pons -dysarthria, clumsy hand

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6
Q

tests to order if pt presents with possible acute stroke

A

noncontrast CT brain, EKG CXR, CBC, plts, PT/PTT, serum e-lytes, glucose, b/l carotid US, Echo

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7
Q

anticoagulants given in acute ischemic stroke?

A

no, not unless caused by emboli

ASA indicated unless tPA given, if CI to ASA give clopidogrel (Plavix) then ticlopidine

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8
Q

carotid endarterectomy is indicated when ?

A

carotid stenosis +70% + symptoms

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9
Q

causes of intracerebral hemorrhage (ICH)

A

HTN*, amyloid angiopathy, anticoag/tPA use, brain tumors, AVM
basal ganglia most common site, then pons, cerebellum

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10
Q

cocaine use is associated with what types of stroke

A

ICH, SAH, ischemic

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11
Q

goal BP in ICH

vs goal in ischemic stroke

A

less than 160-180/105

less than 220/120 in order to preserve the penumbra

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12
Q

when to perform LP in stroke

A

when CT scan is unremarkable and clinical suspicion for SAH is high and papilledema is NOT present (may cause herniation)
-xanthrochromia +/- blood in SCF (non traumatic tap) +/- is diagnostic

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13
Q

once SAH diagnosed, next steps

A

cerebral angiogram: locate site of bleeding and clip site

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14
Q

goal in Parkinson’s treatment

A

enhance deficient dopaminergic system: carbidopa-levodopa (Sinemet), bromocriptine, pramipexole, selegeline (MAOB-i)
or inhibit uninhibited cholinergic system: trihexyphenidyle, benztropine, amitriptyline (not in old ppl)
others: amantidine-antiviral (not anymore?), deep brain stimulation if refractory

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15
Q

treatment of Tourette’s

A

clonidine, pimozide, haloperidol

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16
Q

tests when considering dementia

A

CBC with diff, CMP, TSH/T4, B12, folate, VDRL, HIV, CT/MRI of head

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17
Q

tx for Meniere’s

A

salt restriction, thiazide diuretics

meclizine for symptoms

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18
Q

diagnosis of Guillain Barre

treatment?

A

LP shows lots of protein and few cells
IVIG = plasmaphoresis
NEVER steroids!

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19
Q

myasthenia gravis crisis tx

management tx

A

plasmaphoresis = IVIG, + steroids

management: Acetylcholinesterase inhibitor (pyridostigmine) then steroids, azathioprine, or mycophenolate mofetil

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20
Q

MS treatment
exacerbation
management

A

acute attack: steroids, if cannot tolerate use plasmapheresis
management: INF-B or glatiramer

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21
Q

if suspect SLE, get what Ab test first?

A

ANA (most sensitive and cheap)

if positive THEN anti-double stranded DNA (more specific) to confirm

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22
Q

older pt with unilateral weakness in UE more than LE after car accident +/- pain/temp deficit think?

A

central cord syndrome (hyperextension injury)

23
Q

apraxia (expressive aphasia) is seen in infarct to what area?

A

dominant frontal lobe (Broca’s area)

i.e. left MCA lesion will result in right hemiparesis and aphasia

24
Q

Brown-Sequard presentation

A

same side of lesion: hemiparesis (lateral corticospinal) and loss of proprioception, vibration and light touch (dorsal columns) at level of lesion and below
contralateral loss of pain/temp 1-2 levels below lesion (lateral SpTT, decussates 1-2 levels above entrance into SC)

25
Q

Delivery of O2 equation

A

DLO2 = CO x Hgb x %Sat

26
Q

labs that can ddx hemolysis from hemorrhage in normocytic anemia (but will actually just see the bleeding if hemorrhage)

A

hemolysis will have ^LDH, ^T. Bili/D. Bili, decreased haptoglobin
next step if hemolysis: blood smear

27
Q

normocytic anemia not caused by destruction (hemorrhage/hemolysis)

A

marrow malignancy: leukemia, myelodysplasia

CKD, BM fibrosis, tumor, aplastic anemia, anemia of chronic disease (poss. microcytic)

28
Q

common triggers of G6PD deficiency

A 
dapsone
TMPSMX
nitrofurantoin
primaquine
dimercaprol
(fava beans- Greek variant)
infection
29
Q

dx and tx of paroxysmal nocturnal hemoglobinuria (PNH)

A

flow cytometry shows CD55- cells

tx: eculizumab

30
Q

causes of nonmegaloblastic macrocytic anemia

A

cirrhosis, alcoholism, drugs (5-FU, AZT), metabolic disease (Lesch-Nyhan, Hereditary Orotic Aciduria)

31
Q

TTP vs DIC

A

both have low platelets and schistocytes
TTP will have normal PT/PTT, INR, fibrinogen, D-dimer
DIC will have ^PT/PTT, ^INR, decreased fibrinogen, ^D-dimer
also, just use plasmapheresis in TTP, platelets are contraindicated
platelet transfusion recommended in DIC if plts drop below 30,000

32
Q

TTP presentation (acronym)

A 
FAT RN
Fever
Anemia (MIHA)
Thrombocytopenia
Renal failure
Neuro symptoms
33
Q

Therapy for non-Hodgkin Lymphoma

A 
R-CHOP
Rituximab
Cyclyphosphomide
Hydroxydaunomycin (doxorubicin)
Oncovin (vincristine)
Prednisone
34
Q

MM vs Waldenstrom vs MGUS

A

MM: +10% plasma cells (HSCT, Melphagan chemo)
Waldenstrom: +10% lymphoma cells (Ritux chemo)
MGUS: no increase (W/W)

35
Q

MM dx

A

10%+ plasma cells, +SPEP, +UPEP, +bone survey (lytic lesions)

36
Q

headaches, dizziness, nausea, polycythemia (^HCT) think?

A 
CO poisoning (carboxyhgb)
dx with ABG (pulse ox can't ddx)
37
Q

tumor lysis syndrome
electrolyte abnormalities?
adverse effects?
how to prevent?

A

^uric acid, ^K+, ^phos, low Ca2+ (phis binds/precipitates Ca2+)
cardiac arrhythmias, n/v/d, cramps, seizures, tetany, AKI
IVF, allopurinol, rasburicase

38
Q

findings in MM

A

^Ca2+, normocytic anemia, renal insufficiency, protein gap (T. protein- albumin 4+)

39
Q

polycythemia vera treatment

A

phlebotomy, hydroxyurea if high risk thrombosis (BM suppression)

40
Q

why are asplenic pts more likely to have infections from encapsulated organisms?

A

deficient in antibody mediated phagocytosis (opsonization) and antibody-mediated complement activation
S. pneumo, Hib, N. menigitis

41
Q

what is hyposthenuria?

A

impaired ability of kidney to concentrate urine, found in SCD pts and those with trait
RBC sickling in vasa rectae of inner medulla, impairing countercurrent exchange and free water reabsorption

42
Q

normocytic anemia, splenomegaly, reticulocytosis, jaundice with ^I.Bili, ^LDH, decreased haptoglobin, think ?

A

AIHA

tx with glucocorticoids

43
Q

how to dx CLL

A

flow cytometry

44
Q

osteoid osteoma on imaging

A

sclerotic, cortical lesion with central nidus of lucency
pain worse at night and unrelated to activity
relieved by NSAIDs

45
Q

giant cell tumor of bone presentation (GCTB)

A

“soap-bubble” appearance in epiphyseal regions commonly femur and tibia around knee

y. adult with decreased ROM, pain and swelling
tx: surgery is first-line

46
Q

lab derangements in hereditary spherocytosis

A

low MCV, ^RWD, osmotic fragiligy test, eosin-5-maleimide binding test, ^MCHC (Hgb concentration)
dx:
tx: splenectomy
increased risk of bilirubin gallstones and Parvo B19 infection–>aplastic anemia

47
Q

PT/PTT in von Willebrand

A

^PTT, ^bleeding time, normal PT

48
Q

acute hemolytic transfusion reaction

A

fever, flank pain, hgburia, renal failure, DIC w.in 1 hr of transfusion
dx with direct Coombs test, pink plasma
caused by ABO incompatibility

49
Q

medications that can induce methemoglubinemia

A

topical anesthetics (benzocaine), dapsone, nitrates (in infants)
cause iron component of Hgb to be oxidized forming methemoglobin which cannot bind O2
pulse Ox commonly at 85%, ABG may be falsely elevated (doesn’t base on true Hgb-O2 binding)–>large O2 saturation gap
tx: methylene blue

50
Q

thyroid storm tx

A

IVF, cooling blankets
propranol (reduce sympathetic symptoms)
PTU, methimazole (thionamides- inhibit thyroid synthesis)
steroids (reduce peripheral T4–>T3)

51
Q

surgery vs radioactive ablation for hyperthyroidism

A

surgery for Graves as pretibial myxedema and exopthalmos will persia
radioactive ablation for other causes

52
Q

SIADH tx

A

water restriction
tx underlying cause
demeclocycine, lithium

53
Q

diabetes insipidus tx

A

central DI: DDAVP

nephrogenic: gentle diurese with HCTZ, amilioride

54
Q

metformin is contraindicated in..

A

CKD, CHF, liver disease

IM Uworld (16 decks)

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