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IM Uworld > 4 > Flashcards

4 Flashcards

1
Q

management of cocaine-induced angina

A

IV benzos: improve agitation, reduced myocardial O2 demand, alleviate CV symptoms (lower BP/HR)
also ASA, nitro, CCBs (vasodilate)
NO B-blockers

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2
Q

if PaCO2 acutely rises from 40 to 65 mmHg what would you expect the pH to be

A

about 7.20 (decreases .08 for every 10 mmHg increase in PaCO2)
if pH closer to normal, consider compensation by increasing renal HCO3- retention in the chronic setting (COPD) as it takes about 48 hrs

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3
Q

lymphadenopathy in strep vs mono

A

strep: cervical
mono: typically cervical but may be generalized

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4
Q

acute HIV vs mono

A

presentation may be similar but in acute HIV rash + diarrhea are common, tonsillar exudates are not usually present (opposite for mono)

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5
Q

labs in cases of recent atheroembolism

A

eosinophilia, eosinophiluria, low complement

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6
Q

CMV retinitis presentation, complications, and treatment

A

blurred vision, floaters, photopsia (flashes)
blindness, retinal detachment
yellow/white fluffy hemorrhagic lesions along vasculature (vs toxo: eye pain, decr. vision; doesn’t follow vasculature)
valganciclovir, if near fovea or optic nerve add intravitreal injections

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7
Q

how is bone loss a complication of untreated hyperthyroidism?

A

^T3–>^osteoclast activity–>^Ca2+–>decr. PTH secretion–>decr. renal Ca2+ reabsorption–>^Ca2+ in urine, net wasting
also decr. conversion to active vit D (1,25OH–>25-OH)–>decr. GI Ca2+ absorption and decr. renal Ca2+ reabsorption

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8
Q

complications of Graves but not toxic adenoma (both hyperthyroid)

A

fetal hyperthyroidism: TSH receptor (TSHR) Abs cross placenta
proptosis, impaired ocular movement, ocular irritation/redness/vision loss from infiltrative process

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9
Q

acoustic neuroma symptoms

A

vertigo, UNILATERAL tinnitus, sensorineural hearing loss

similar to Meniere (+aural fullness)

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10
Q

causes of aortic stenosis

A

if >70: senile calcific aortic stenosis

bicuspid aortic valve, and lastly rheumatic heart disease

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11
Q

how you get cyanide poisoning vs methemoglobinemia

A

cyanide poisoning: smoke inhalation injury (also CO poisoning); binds to Fe3+ in cytochrome oxidase a3 in mitochondrial ETC–>blocks oxidative phosphorylation–>anaerobic metabolism–>lactic acidosis

methemoglobinemia: exposure to oxidizing agents: dapson, nitrates, topical/local anesthetics)
Fe2+–>Fe3+ resultes in left shift of O2 dissociation curve–>reduced delivery

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12
Q

cyanide poisoning tx

A

hydroxocobalamin or sodium thiosulfate: directly nine cyanide molecules
OR induce methemoglobinemia with nitrites to increase ferric iron (Fe3+) which binds cyanide

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13
Q

first step if suspect TTP?

A

peripheral blood smear, may show signs of intravascular hemolysis (schistocytes)
tx: plasma exchange +/- steroids

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14
Q

is RAAS activated or inactivated in CHF?

A

activated in order to maintain CO and systemic pressure

-leads to vasoconstriction of efferent (leaving) renal arteriole in order to maintain GFR

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15
Q

suspect what in pt with RHF following placement of implantable pacemaker or ICD

A

tricuspid regurgitation

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16
Q

lesions in toxo vs PML vs primary CNS lymphoma

A

toxo: MULTIPLE ring-enhancing, spherical lesions in the basal ganglia

progressive multifocal leukoencephalopathy (PML):
NON-ENHANCING and do not produce mass effects

primary CNS lymphoma: SOLITARY, weakly ring-enhancing periventricular mass

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17
Q

presence of what in the CSF is specific for primary CNS lymphoma?

A

EBV DNA

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18
Q

what is relative risk? (RR)

A

risk of an outcome in an exposed group / risk of an outcome in an unexposed group

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19
Q

initial management of relatively young pt. presenting with sciatica

A

NSAIDs or acetaminophen as XR will not likely change initial management (if no risk factors for osteoporosis and no inciting events)
MRI not indicated unless alarm symptoms (saddle anesthesia, fever, IVDU (epidural abcess))

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20
Q

tx of basal cell carcinoma depends on lesion type and location

A

low-risk/nodular lesions on trunk/extremities: electrodessication and curettage (ED/C) or surgical excision with 3-5mm margins
high-risk lesions or on face: Mohs procedure
low-risk superficial lesions or actinic keratosis: topical 5-fluorouracil or imiquimod
radiation occasional if unable to undergo sx excision, systemic chemo if widely metastatic BCC

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21
Q

recurrent high fevers, arthritis/arthralgias, salmon colored maculopapular rash, ESR may be ^

A

Adult Still disease

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22
Q

modified Duke criteria

A

major:
- blood cx + for S. viridans, S. aureus, Enterococcus
- echo showing valvular vegetation

minor:
- predisposing cardiac lesion
- IVDU
- temp 38+
- embolic phenom (infarcts, myc. aneurysm, Janeways)
- immunologic phenom (Oslers, Roth spots)
- +blood cx other than typicals

definite IE: 2 major OR 1 major + 3 minor
possible IE: 1 major + 2 minor OR 3 minor

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23
Q

what is enthesitis and what condition is it seen in ?

A

tenderness at tendon insertion sites
may be isolated heel pain
ankylosing spondylitis, psoriatic arthritis, reactive arthritis
other findings: loss of spinal mobility, pain improves with activity

24
Q

deficiencies in primary vs secondary adrenal insufficiency

A

primary (adrenal prob): loss of glucocort/mineralcort/androgen secretion

secondary (pit prob): only loss of glucocort/androgen, mineralcort preserved as it is controlled by RAAS
will not see hyponatremia, hyperkalemia, hypotension, hyperchloremic acidosis, hyperpigmentation

25
Q

pt with hx of malignancy presents with back pain with motor and sensory abnormalities, what do you suspect?what should you do?

A

epidural spinal cord compression

IV steroids and MRI

26
Q

rash of HSV

A

erythema multiforme: targetoid plaques

27
Q

malaria ppx

A

chloroquine resistance is common

atovaquoine-proguanil, doxycycline, or mefloquine (2 weeks before, 4 weeks after)

28
Q

most common causes of secondary clubbing

A

lung malignancies, CF, R–>L cardiac shunts

COPD +/- hypoxemia does NOT cause clubbing

29
Q

complication of giant cell arteritis

A

aortic aneurysm; follow with serial CXR

30
Q

consider what ? when pt presents parkinsonism features, orthostatic hypotension, impotence, incontinence, neuro signs

A

Shy-Drager syndrome (multiple system atrophy)

tx to expand intravascular volume: fludrocortisone, salt supplementation, a-adrenergics

31
Q

autosomal recessive familial dysautonomia in Ashkenazi Jewish kids
dysfunction of autonomic nervous system with severe orthostatic hypotension

A

Riley Day syndrome

32
Q

if lose a significant number of study participants, may result in ? bias which is what type of bias

A

attrition bias, a form of selection bias as the subjects lost may differ in a meaningful way from those still in the study

33
Q

recurrent respiratory and GI infections, autoimmune disease, chronic lung disease, think ?

A

common variable immunodeficiency
very low IgG, low IgM, IgA
resp infections: otitis, sinusitis, pneumonia
GI: salmonella, campylobacter, giardiasis, candida, PJP
dx: quantitative Ig levels
tx: Ig replacement therapy

34
Q

“matching” study participants with controls of same age/race/location aims to prevent what phenomenon?

A

confounding

35
Q

S4 is due to ?

seen in ?

A

blood forced into stiff ventricle (atrial gallop)
healthy older adults (non pathological)
pathologic in y. adults/kids
venticular hypertrophy, acute MI

36
Q

S3 is due to ?

seen in ?

A

turbulent blood flow into ventricles due to increased volume (ventricular gallop)
nonpathologic in kids, y. adults, pregnancy
pathologic in 40+, heart failure, restrictive CM, high output states

37
Q

pulsus paradoxes seen in ?

A

cardiac tamponade
severe asthma, COPD, hypovolemic shock, constrictive pericarditis
(drop 10+ in SBP during inspiration)

38
Q

necrolytic migratory erythema, DM, hyperglycemia, GI symptoms, anemia, weight loss

A

glucagonoma (glucagon 500+)

39
Q

characteristics of TCA OD

next best step in management for cardiac tox?

A

CNS symptoms: delirium, coma, seizures, resp. distress

cardiac: tachy, hypotension, prolong QRS, arrhythmias
anticholinergic: dry mouth, blurry vision, dilated pupils, urinary reten, flush, hyperthermia

HCO3- to tx cardiac toxicity (prolonged QRS duration-100+ msec and Vtach/Vfib)
benzos used to tx secures

40
Q

how to dx lesion caused by Malassezia spp.

tx?

A

KOH prep

topical ketoconazole, terbinafine, selenium sulfide

41
Q

most common cause of primary adrenal insufficiency in developed countries
how does it differ from central causes?

A

autoimmune adrenalitis

hyperpigmentation and hyperkalemia not seen in central

42
Q

drugs indicated in photosensitivity reactions

A

tetracyclines (doxy), chlopromazine, prochlorperazine (antipsychs), lasix, HCTZ, amiodarone, promethazine, piroxicam

43
Q

what is sialadenosis?

A

benign, noniflammatory enlargement of the salivary glands seen in pts with advanced liver disease as well as dietary/nutritional disorders

44
Q

when is desensitization to PCN appropriate in contrast to alternative tx (which is?)

A

desn. required for pts with CNS infection, who have had multiple tx failures, or are pregnant (high risk of transplacental transmission)
alternative: doxycycline x14 days for primary (chancre) and secondary (rash), x28 days for latent (asymp); ceftriaxone x14 ds for tertiary (gummas, CV)

45
Q

what indicates success in syphilis tx

A

4x decrease in ab titers (RPR) in 6-12 months

46
Q

comedonal acne tx

A

topical retinoids, salicylic/azelaic/glycolic acid

47
Q

inflammatory acne tx

A

mild: topical retinoids + benzoyl peroxide
moderate: add topical abx (erythromycin, clindamycin)
severe: add oral abx

48
Q

nodular (cystic) acne tx

A

moderate: topical retinoid +benzoyl peroxide + topical abx
severe: add oral abx
unresponsive severe: oral isotretinoin

49
Q

exertional heat stroke defined as

A

temp 104+ with CNS dysfunction

+/- dehydration, hypotension, tachycardia, seizures, acute resp. distress syndrome, DIC, hepatic/renal failure

50
Q

if positive acetylcholine receptor antibody assay, what to suspect and do next?

A

myasthenia gravis
get CXR to look for thymoma
Ab test is more specific than Tensilon/edrophonium test so it is redundant

51
Q

can only accept what types of gifts from drug reps

A

nonmonetary gifts of minimal value that directly benefit the pt (educational material, drug samples)

52
Q

watery diarrhea, muscle weakness/cramps (hypokalemia), hypo/achlorhydria (due to decreased gastric acid secretion) think ?

A

VIPoma (75+)

53
Q

steatorrhea, hepatomegaly, PUD, skin symptoms (pruritus, flushing, urticaria)

A

systemic mastocytosis

54
Q

splenectomy is indicated in what anemic conditions

A

spherocytosis, AIHA, B-thalassemia major (+massive splenmeg) or Hgb H disease

55
Q

tx for coronary artery vasospasm

A

diltiazem, amlodipine

56
Q

if monospot test is negative but highly suspect mono…

A

consider EBV still as there is a 25% false-negative rate during 1st week of illness

57
Q

highest risk factor for stroke

A

HTN

ischemic and hemorrhagic

IM Uworld (16 decks)

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