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IM Uworld > 7 > Flashcards

7 Flashcards

1
Q

the development of clubbing and acute joint pain in a chronic smoker, think ?

A

hypertrophic osteoarthropathy

associated with lung cancer, get a CXR

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2
Q

abx for human bite wounds

A

augmentin

clindamycin does not get G- (Eikenella) and ampicillin or cipro do not get anaerobes

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3
Q

proptosis in Graves is caused by ?

A

orbital tissue expansion via T cell activation and stimulation of orbital fibroblasts by thyrotropin (TSH) receptor antibodies

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4
Q

pseudogout finding on XR

A

chondrocalcinosis: calcification of articular cartilage

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5
Q

1 cause of M/M in PAD patients

A

cardiovascular disease, i.e. MI

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6
Q

veins that are the most common source of symptomatic PE

A

proximal deep leg veins: femoral, iliac, popliteal

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7
Q

elevated prolactin, low TSH, T4, LH, testosterone, think ?

A

pituitary adenoma
in contrast, hyperprolactinemia caused by meds i.e. antipsychotics (risperdone) will not alter other hormone levels (D2 antagonist, don’t alter HPA axis)

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8
Q

how to dx ankylosing spondylitis

A

XR of sacroiliac joints

HLA-B27 is not sn/sp

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9
Q

how to manage a macroprolactinoma (10mm+)?

A

dopamine antagonists i.e. bromocriptine, cabergoline

use transphenoidal resection if 3cm+ or increases in size on tx

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10
Q

tx of choice for Paget’s disease of bone

A

bisphosphonates

inhibit osteoclasts and suppress bone turnover

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11
Q

suspect what in pts with flash pulmonary edema, rise in Cr 30%+, diffuse atheroslcerosis, asymmetric kidney size

A

renovascular HTN
may have abdominal bruit
may have onset after 55
likely resistant to 3+ antihypertensives

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12
Q

intracranial bleed vs thrombotic vs embolic vs lacunar stroke

A

IC bleed symptoms progressively worsen +/- signs of ^ICP: vomiting, headache, loss of alertness, bradycardia
thrombotic symptoms fluctuate with periods of improvement
embolic symptoms are maximal at onset
lacunar: have severe focal neuro signs like bleed but no s/s of ^ICP

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13
Q

thoracentesis is tx of choice in patients with pleural effusion except in cases of ?

A

obvious CHF: fluid overload, pedal edema, crackles b/l

do trial of diuretics

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14
Q

how to manage pts with severe hyperthyroidism

A

medical tx first with methimazole or PTU and B-blocker, then radioactive iodine or thyroidectomy

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15
Q

during what studies are exposure and outcome measured simultaneously

A

cross-sectional study

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16
Q

CML LAP?

A

low leukocyte alkaline phosphatase score

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17
Q

why is NaHCO3- used in TCA OD?

A

the increase in pH and extracellular sodium alleviate cardio-depressant action on sodium channels
TCA cardiac toxicity: prolonged QRS 100ms+, ventricular arrhythmias

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18
Q

COPDers should get home O2 treatment if ?

A

PaO2 less than 55mHg or SaO2 is less than 88%

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19
Q

immunosuppressed pt develops pneumonia with elevated LDH, think ?
how to dx?

A

PJP

dx with sputum microscopy with specialized stains; bronchoalveolar lavage if necessary

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20
Q

how does type 4 RTA manifest? who is it seen in ?

A

hyperkalemia, non-anion gap metabolic acidosis, mild-mod renal insufficiency
seen in poorly controlled DM

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21
Q

hydroxychloroquine SE

A

retinopathy

22
Q

initial tests to do in adrenal insufficiency

A

AM cortisol and ACTH stim test

23
Q

normal TSH, T4 with low T3

A

euthyroid “sick” syndrome

24
Q

skin ulcer associated with a chronic scar, think ?

what to do?

A

Squamous cell carcinoma; increased risk metastasis (Marjolin ulcer)
biopsy

25
Q

how to calculate Number Needed to Treat (NNT)

A

inverse of Absolute Risk Reduction
i.e. if risk decreased from 16% (control) to 12% (case)
0.16-0.12 = 0.04
1/0.04 = 25 people NNT

26
Q

peripheral edema, ^JVP, hepatomegaly, ascites, think ?

A

constrictive pericarditis

27
Q

what pts should get a statin regardless of LDL levels

A

DM pts age 45-70

28
Q

what can cause idiopathic intracranial hypertension?

A

(besides being an obese female)

growth hormone, tetracyclines and vitamin A derivatives (isotretinoin)

29
Q

fatigue, arthralgias and porphyria cutanea tarda, think ?

A

Hepatitis C

30
Q

digitalis causes what cardiac effects leading to what EKG manifestations

A

ectopy and increased vagal tone leading to atrial tachycardia with AV block

31
Q

megaloblastic anemia, atrophic glossitis (shiny tongue), vitiligo, thyroid disease, neuro abnormalities in northern European think

A

pernicious anemia

32
Q

a common cause of Addison’s disease (primary adrenal insufficiency) in endemic areas
metabolic derangements

A

TB

non-anion gap metabolic acidosis and hyperkalemia

33
Q

cauda equina (spinal nerve roots) vs conus medullaris syndrome

A 
cauda equina (nerves separated): typ. b/l, radicular pain, saddle anesthesia, asymmetric motor weakness, hypo/areflexia
conus medullaris: sev. back pain, perianal anesthesia, symmetric motor weakness, hyperreflexia (UMN and LMN)
34
Q

tx of botulism

A

horse-derived antitoxin

35
Q

feature of low back pain that suggest an inflammatory cause

examples: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, IBD-associated arthritis

A

gradual onset, younger than 40, pain at night that does not improve with rest, improvement with activity

36
Q

what site do immune mediated spondyloarthropathies affect

A

ligamentous insertions (enthesitis)

37
Q

tendency of study population to affect the outcome since they are aware they are being studied

A

Hawthorne effect

38
Q

deposition of calcium and phosphorus in the skin–>whitish papules, plaques, nodules

A

calcinosis cutis

39
Q 
what is affected?
chondrosarcoma
OA
Rheumatoid nodules
Chronic tophaceous gout
A

chondrosarcoma: pelvis, femur, humerus
OA: DIPs and PIPs
Rheumatoid nodules: elbow, proximal ulna
Chronic tophaceous gout: urate crystals can be deposited in skin, resulting in tumors with a chalky white appearance

40
Q

metabolic derangement in hyperaldosteronism

A

metabolic alkalosis
^aldo, decreased renin
HTN, mild hypernatremia, hypokalemia

41
Q

thrombolytics in DVT?

A

reserved for hemodynamically unstable pts with PE, less commonly for massive proximal DVT with significant symptomatic swelling =/- limb ischemia

42
Q

alternative to warfarin in tx of acute DVT/PE

A

direct Xa inhibitors: rivaroxaban, apixaban

do NOT use in severely impaired renal function or DVT/PE secondary to malignancy

43
Q

immunocompromised pt with fever, pleuritic CP and hemoptysis think ?

A

invasive aspergillosis
CT scan: pulmonary nodules with surrounding ground-glass opacities (“halo sign”)
tx: voriconazole and an echinocandin (caspofungin)
(PJP rarely has hemoptysis or productive cough)

44
Q

small vs large nerve fiber injury

A

small: POSITIVE s/s: pain parenthesis, allodynia
large: NEGATIVE s/s: numbness, loss of proprioception/vibration sense (ataxia, +Romberg), diminished ankle reflexes, weakness of intrinsic feet muscles (hammer toe deformity)

45
Q

progressive DOE and fatigue 2 weeks following MI

A

ventricular aneurysm

46
Q

what findings on EKG with ventricular aneurysm? (post-MI)

A

persistent ST-segment elevation PLUS deep Q waves

47
Q

what to do with PPD 8mm in asymptomatic HIV pt

A

greater than 5mm is positive, in absence of active TB symptoms, tx with 9 months INH and pyridoxine

if CD4+ less than 200 may have false negative

48
Q

acid-base disturbance in ASA toxicity

A 
low PaCO2 (resp. alkalosis), low HCO3- (metabolic acidosis)
pH typically in the NORMAL range due to mixed picture
eventually metabolic acidosis will predominate if untreated
49
Q

tx of neutropenic fever

A

anti-pseudomonal agents: cefepime, meropenem, pip-tazo (zosyn)

50
Q

SOB, productive cough, destruction of lower lung lobes (decreased breath sounds, basilar lucency on CXR), think ?

A

alpha-1 antitrypsin deficiency
panacimar emphysema results in greater destruction of lower lobes
(consider in younger patient, minimal smoking hx, basilar COPD, unexplained liver disease)

IM Uworld (16 decks)

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