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IM Uworld > 9 > Flashcards

9 Flashcards

1
Q

only do rabies post-exposure prophylaxis if ?

A

animal is unavailable or symptomatic

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2
Q

diarrhea in AIDS pt

A

think Cryptosporidium parvum (CD4 less than 180)
CMV typically causes colitis, esophagitis, retinitis, may cause frequent small volume stools +/- blood (typically CD4 less than 50!)

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3
Q

how do anticholinergics cause urinary retention

A

impaired detrusor muscle contraction
less so due to impaired internal sphincter relaxation
(PS input from pelvic splanchnic nerves

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4
Q

what is generalizability (aka external validity)?

A

applicability of obtained results beyond the cohort studied

“How generalizable are the results of a study to other populations?”

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5
Q

IgM spike think ?

what are consequences of this condition?

A

Waldenstrom macroglobulinemia

hyperviscosity, neuropathy, cryoglobulinemia, bleeding, hepsplenmeg, LAD

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6
Q

strawberry vs cherry hemangioma

A

strawberry: kids (think strawberry shortcake)

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7
Q

cavernous hemangiomas of the brain/viscera are associated with

A

von Hippel-Lindau disease

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8
Q

pneumococcal vaccines to give to chronic liver disease patients

A

PPSV23 alone

then PCV13 and PPSV23 at age 65

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9
Q

treatment of symptomatic hyperPTH

A

parathyroidectomy

bisphosphonate therapy if decline

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10
Q

when to CT in hyperPTH

A

if suspect malignancy: severe, symptomatic hypocalcemia, low PTH, elevated PTHrP
if suspect MEN: evidence of multi glandular hyperPTH or additional endocrine tumors

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11
Q

MEN1

A

PPP (primary)
hyperPTH (^Ca2+)
Pituitary tumors (PRL, vision changes)
Pancreatic tumors (gastrinoma)

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12
Q

MEN2A

A

MPP (middle)
Medullary thyroid cancer (calcitonin)
Pheochromocytoma
Parathyroid hyperplasia

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13
Q

MEN2B

A

MPM (2 Big Ms)
Medullary thyroid cancer (calcitonin)
Pheochromocytoma
Mucosal neuromas/marfanoid habitus

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14
Q

acute thyrotoxicosis with mild thyroid enlargement, suppressed TSH, and decreased radio iodine uptake think ?

A

painless thyroiditis

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15
Q

how to manage infective endocarditis with cardioembolic stroke

A

IV antibiotics, observation

antiplatelet, anticoagulants not indicated

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16
Q

if dirty wound but completed tetanus vaccines as child (3+ tetanus toxoid doses) ?

A

only Tdap if haven’t had in last 5 years

NO TIG

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17
Q

if dirty wound and uncertain history or did not complete vaccines as child

A

Tdap + TIG

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18
Q

if clean wound and received all childhood tetanus vaccines

A

only Tdap if haven’t had in last 10 years

NO TIG

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19
Q

if clean wound and uncertain history or did not complete vaccines as child

A

only Tdap

NO TIG

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20
Q

fatigue, arthralgias, peripheral neuropathy

low C3, C4, RF+, ^AST, ALT, kidney injury, palpable purple lesions on leg, think ?

A

mixed cyroglobulinemia:

immune complex deposition disorder associated with chronic hep C

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21
Q

calcium oxalate crystals and hypocalcemia are associated with what ingestion?
what should be given?

A

ethylene glycol
fomepizole or etOH to inhibit alcohol dehydrogenase
+/- NaHCO3- to alleviate the acidosis
hemodialysis if severe

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22
Q

fibromyalgia tx

A

amitriptyline, pregabalin, duloxetine, milnacipran

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23
Q

S3 is associated with ?

what treatment typically indicated?

A

LV failure

IV diuretics for decompensated HF

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24
Q

post-exposure prophylaxis for HIV exposure

A

3+ drug regimen started immediately for 4 weeks

i.e. 2 NTRI/NSRI + Integrase strand transfer inhitibor, PI, or NNSRI

25
painful, red eye with opacification and ulceration of the cornea associated with contact lenses, think ?
pseudomonal keratitis ddx: acute angle-closure glaucoma typically does not have ulceration and pupil is fixed and mid-dilated anterior uveitis typically spares the cornea
26
what meningitis most likely to present with shock and petechial rash
meningococcal
27
Echinococcus granulosus vs Entamoeba histolytica
both involve liver abscesses E. granulosus may be afebrile and liver cysts have "daughter" cytes (internal septations) E. histolytic typically is febrile +/- dysentery/colitis, cyst is smooth and has a capsule
28
how does oral estrogen therapy affect thyroid hormones?
decrease clearance of thyroxine-binding globuline (TBG) leading to elevated levels this leads to less FREE thyroxine and ^TSH in thyroid-dependent patients, may need to increase levothyroxine dose (also ^ in pregnancy)
29
what drugs decrease levothyroxine absorption
cholestyramine, iron, calcium, aluminum hydroxide, PPIs, sulcralfate
30
what drugs ^TBG concentration
estrogen, tamoxifen, raloxifene, heroin, methadone
31
what drugs decrease TBG concentration
androgens, steroids, nicotinic acid
32
what drugs ^thyroid hormone metabolism
rifampin, phenytoin, carbamazepine, phenobarbital
33
dyspnea, tachypnea, tachycardia, hypoxia worsened with IVF + patchy irregular alveolar infiltrates on CXR, think ?
pulmonary contusion commonly caused by blunt thoracic trauma, initial CXR may be negative, CT is more sensitive in contrast, hemothorax will present with pleural effusion on CXR
34
info to include on signout
DNR/DNI, hospital course and recent events, current condition, anticipatory info ("if the patient's mental status changes, check blood gas and consider transfer back to ICU")
35
eye probs: horldeoum vs chalazion vs dacryocystitis
hordeolum: abscess over eyelid, tender and swollen chalazion: granulomatous inflammation of meibomian gland, hard and painless nodule dacryocystitis: inflammatory changes in medial canthal region of eye
36
``` infective endocarditis etiology associations S. aureus: Viridans: S. epidermidis: Enterococci: S. bovis: Fungi (Candida): ```
S. aureus: prosthetic valves, IV caths, ICDs, IVDU Viridans: gingival manipulation, resp. tract incision/bx S. epidermidis: prosthetic valves, IV caths, ICDs Enterococci: nosocomial UTIs S. bovis: Colon cancer, IBD Fungi (Candida): immunocompromised, IV caths, prolonged abx
37
screening for bladder cancer?
USPSTF recommends AGAINST screening for bladder cancer due to low incidence and poor positive predictive value of screening tests
38
most effective for reducing HTN
weight loss then DASH, Na restriction, exercise, etOH reduction smoking inconclusive but recommended
39
what therapy for managing bone pain in patients with prostate cancer AFTER androgen ablations (orchiectomy)
radiation, focal external beam is a good choice
40
goal PaO2 when ventilating to prevent ARDS | why?
55-80 mmHg, corresponding to about 88-95% O2 sats | FiO2 less than 60% (0.6) are considered generally safe (reduced risk of O2 toxicity)
41
what to give if homocysteinemia
``` vitamin B6 (pyridoxine) lowers homocysteine levels by acting as a cofactor for enzyme cystathionine B-synthase, which metabolizes homocysteine to cystathionine ```
42
best imaging for ureteral/kidney stones
Ultrasound or noncontrast spiral CT
43
hypopituitarism will lead to what levels of | free T4, cortisol, and aldosterone?
low T4, low cortisol, NORMAL aldosterone as ACTH is low resulting in secondary (central) adrenal insufficiency but aldosterone is regulated by RAAS and not affected in hypopituitarism in contrast to primary AI: low aldo, ^ACTH
44
isolated thrombocytopenia think ? | and get what tests?
think ITP BUT diagnosed after excluding other causes such as HIV or Hep C infection thrombocytopenia may be the initial presentation of HIV in 5-10% of pts
45
+VDRL, prolonged PTT, thrombocytopenia, think?
antiphospholipid antibody syndrome, ppx with low dose ASA and LMWH to prevent pregnancy loss in pregnant females
46
RV failure, tachycardic, hypotensive, ^JVD, consider
massive PE
47
fever and sore throat in pt taking antithyroid drug suggests?
agranulocytosis
48
CSF with ^lymphocytes, ^RBCs, ^protein
HSV encephalitis | dx with HSV PCR
49
how to tx pseudotumor cerebri? | complication of untx?
weight reduction, acetazolamide | blindness! use shunting or optic nerve sheath fenestration to prevent
50
pt with HA, n/v, abdominal pain, confusion, tachycardia, tachypnea, and pinkish-skin hue think ?
carbon monoxide poisoning
51
exposure to burning rubber or plastic, bitter almond breath, think ?
cyanide poisoning
52
cyanosis and bluish discoloration of skin and mucous membranes, think ?
methemoglobinemia
53
when to use hinged knee braces vs knee immobilizers
hinged: prevention and treatment of ligamentous injuries immobilizer: patellar fractures or tears of quads or patellar tendon
54
SEs of cyclosporine
nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, tremor
55
tacrolimus SEs
nephrotoxicity, hyperkalemia, HTN, tremor
56
azathioprine SEs
dose-related diarrhea, leukopenia, hepatotoxicity
57
mycophenolate SEs
BM suppression
58
what is haptoglobin? elevated or decreased in hemolytic anemia?
protein that binds free Hbg to form Hgb-haptoglobin complexes that are easily removed by the liver haptoglobin DECREASED in hemolytic anemia
59
AFP is elevated in ?
testicular germ cell tumors and hepatocelluare carcinoma

IM Uworld (16 decks)

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