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IM Uworld > 8 > Flashcards

8 Flashcards

1
Q

what is anemia of CKD due to ?

what must you be careful of?

A

due to EPO deficiency
be carful to ensure adequate iron stores prior to EPO replacement because EPO-induced surge in RBC production can induce and iron-deficient state

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2
Q

relative risk and relative rate are used in what studies

A

cohort, where people are followed over time for occurrence of the disease

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3
Q

what is the measure reported in case-control studies?

A

exposure odds ratio

compares the exposure of ppl with the disease (cases) to the exposure of people without the disease (controls)

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4
Q

pulmonary: dyspnea, cough, reticulonodular infiltrates on CXR
mucocutaneous: papules, nodules
reticuloendothelial: LAD, hepsplenmeg
pancytopenia (BM infiltration)
^AST/ALT/LDH
in immunocompromised patient, think ?

A

histoplasmosis
dx with serum or urine Histoplasma antigen immunoassay
fungal culture takes 4-6 weeks

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5
Q

Systemic sclerosis antibodies

A

ANA
anti-topoisomerase I (anti-Scl-70)
anticentromere (more associated with CREST (limited sclerosis))

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6
Q

what condition has ^anticardiolipin antibodies?

A

antiphospholipid syndrome

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7
Q

what condition is associated with ^anti-smooth muscle antibodies?

A

autoimmune hepatitis

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8
Q

manifestations of systemic sclerosis

A 
CT thickening due to fibroblast dysfunction
skin sclerosis (sclerodactyly) and vascular dysfunction (Raynaud's), esophageal dysmotility, ILD, HTN
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9
Q

migraine abortive therapies

A

triptans, NSAIDs, tylenol, antiemetics (metoclopramide, prochlorperazine), ergots

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10
Q

migraine preventative therapies

A

topiramate, divalproex sodium, TCAs (amitriptyline), B-blockers (propranolol)

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11
Q

first steps if ingestion of +7.5 g acetaminophen

A

activated charcoal if within 4 hours of ingestion

+ serum acetaminophen levels

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12
Q

pts with pernicious anemia are at increased risk of ?

A

gastric cancer (2-3x)

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13
Q

intrathoracic tumor in pt previously treated for Hodgkin lymphoma, think ?

A

secondary malignancy: common in HL pts tx with chemo/radiation, most commonly are lung, breast, thyroid, bone, GI
also ^risk leukemia/non-HL

HL responds well to treatment and is very unlikely to recur

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14
Q

hemi-neglet involves what cranial region?

A

right (non-dominant) parietal lobe

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15
Q

receptive aphasia involves what cranial region?

A

temporal lobe

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16
Q

hemiparesis involves what cranial region?

A

frontal lobe

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17
Q

motor aphasia involves what cranial region?

A

dominant (left) frontal lobe

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18
Q

combination of neuro findings and headache lasting few hours in a teenage pt, think ?

A

hemiplegic migraine

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19
Q

hyperthyroidism but low uptake on RAIU scan, think ?

next step to determine diagnosis?

A

endogenous release of pre-formed thyroid hormone: thyroiditis, iodide exposure
exogenous hormone use
differentiate with thyroglobulin (precursor) which will be high in endogenous and low in exogenous sources

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20
Q

^ anti-thyroid peroxidase antibodies seen in ?
^ alpha-subunit seen in ?
^ TSH receptor antibodies seen in ?

A

^ anti-thyroid peroxidase antibodies: Hashimoto’s (hypothyroidism)
^ alpha-subunit: TSH-secreting pituitary adenomas)
^ TSH receptor antibodies: Graves

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21
Q

initial management of frostbite

A

rapid rewarming of affected tissues in a water bath (around 100 degrees F)
dry (hot air) rewarming not recommended: too difficult to maintain temp control
tPA in severe, limb-threatening cases

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22
Q

dx of follicular thyroid cancer is difficult why?

A

tissue samples appear like benign follicular adenomas unless sample contains the capsule, which will show invasion of tumor capsule and/or blood vessels (hematogenous spread)

23
Q

Hurthle cells are seen in ?

A

large, polygonal cells with eosinophilic cytoplasm with lots of mitochondria seen in follicular thyroid cancer, benign adenomas, and chronic lymphocytic (Hashimoto) thyroiditis (nonspecific)

24
Q

^calcitonin seen in what thyroid cancer

A

medullary thyroid cancer, secreted by parafollicular cells

also in MEN 2

25
Q

what thyroid cancer has LN involvement

A

papillary thyroid cancer

26
Q

when to image in uncomplicated pyelonephritis

A

if no improvement after 48-72 hours of antibiotics

or unusual findings: gross hematuria, suspect obstruction

27
Q

complicated pyelo requires imaging and involves progession to ?
more common in what pts?

A

progression to renal abscesses, emphysematous pyelo, or papillary necrosis
occurs more commonly in DM, immunosuppresion, hx of kidney stones, anatomic abnormalities of urinary tract

28
Q

what do statins do?

how do they contribute to myopathy?

A

inhibit HMG-CoA reductase, prevent conversion of HMG-CoA to mevalonic acid, and increase cell membrane LDL receptors
decrease CoQ10 synthesis–>myopathy

29
Q

Charcot joint is a complication of ?

what will you see on XR?

A

neuropathy and repeated joint trauma

will see loss of cartilage, osteophytes, and loose bodies

30
Q

XR showing overhanging rim of cortical bone (“rat bite” lesion) and punched out erosions, think ?

A

Gout

31
Q

what is intertrigo?

A

Candida infection in intertriginous areas

32
Q

inflamed nodules in intertriginous areas that may be severely scarred, think ?

A

hidradenitis suppurativa (acne inversa)

33
Q

case-control vs. retrospective cohort studies, which one looks at outcome first and then considers associated risk factors?

A

case-control

retrospective cohort studies first look at risk factors and then determine outcome

34
Q

MAC causes what types of infections

how to tx

A

GI and pulmonary (NOT CNS)

tx with clarithromycin and ethambutol

35
Q

what meds can trigger acute closure glaucoma

A

anticholinergics

Atropine

36
Q

what is trihexyphenidyl

A

an anticholinergic used in tx of Parkinsons

37
Q

sudden vision loss and onset of floaters, fundus may be difficult to visualize and dark red glow may be seen

A

vitreous hemorrhage

associated with diabetic retinopathy

38
Q

pts with Paget disease of bone are at risk of developing ?

A

CN nerve dysfunction and hearing loss (if cranial bones involved)

39
Q

meds that induce priaprism

A

prazosin, trazodone

40
Q

initial tests in Cushing syndrome

A

confirm hypercortisolism with late-night salivary cortisol assay, 24-hr urine free cortisol, +/- overnight low-dose dexamethasone suppression test
(NOT early morning cortisol level: may be low-normal)
2 should be abnormal to confirm

41
Q

next tests in Cushing after confirm hypercortisolism

A

measure ACTH levels to differentiate ACTH-dependent (Cushing disease, ectopic ACTH) vs independent (adrenal adenoma)

42
Q

pyoderma gangrenosum vs ecthyma gangrenosum

A

pyoderma: associated with systemic disease (i.e. IBD), ulcer with purulent base
ecthyma: associated with Pseudomonas–>necrotic ulcers

43
Q

what may still be present in brain death

A

spinal cord function, so DTRs may still be present

definition: absent cortical and brain stem functions

44
Q

RA affects what joints

A

MTPs, PIPs, MTPs of toes, wrist joints, Cervical spine

in contrast, seronegative spondyloarthropathies affect sacroiliac joints

45
Q

polymyositis vs hypothyroid myopathy (both may present with proximal muscle weakness)

A

polymyositis: ^ESR and CK (50% of time), myalgias typically absent/mild, normal DTRs, dx with biopsy
hypothyroid: ^CK, myalgias, fatigue, delayed reflexes

46
Q

oculomotor nerve palsy may occur with ?

A 
nerve compression (PCA aneurysm or uncal hermiation) or more likely microvascular nerve ischemia due to DM, as oculomotor functions are INSIDE of nerve (parasymp. fibers are at periphery) 
so compression is more likely to cause mydriasis
47
Q

diagnosis of myasthenia gravis can be supported with ?

A

ice pack test
cold temp inhibits breakdown of ACh at NMJ, improving muscle strength
confirm with ACh receptor Abs

48
Q

what to suspect if hemolytic anemia, hemoglobinuria, cytopenia, and hyper coagulable state (thromboses)

A

paroxysmal nocturnal hemoglobinuria (PNH)

will see ^LDH, ^I Bili, and low haptoglobin

49
Q

tx for PNH

A

iron, folate

eculizumab (monoclonal Ab that inhibits complement activation)

50
Q

unilateral varicocele that fails to empty when recumbent, hematuria, ^Hgb, suspect?
what test to get?

A

renal cell carcinoma
mass obstructs blood flow
get abdominal CT

51
Q

mono-like syndrome: fever, night sweats, LAD, arthralgias, diarrhea, think ?

A

acute HIV infection

IBD pts rarely have extra intestinal manifestations on initial presentation (less than 10%)

52
Q

anserine bursitis presentation

A

obese diabetic female with tenderness over anteromedial tibia over weeks-months
worse in AM and DO NOT typically have crepitus or joint effusion

53
Q

diffuse dermal scaling, skin appears dry and rough, think?

A

ichthyosis vulgaris
chronic inherited skin disorder
tx with emollients, keratolytics, topical retinoids

IM Uworld (16 decks)

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