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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
Q

painful, red eye with opacification and ulceration of the cornea associated with contact lenses, think ?

A

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
Q

what meningitis most likely to present with shock and petechial rash

A

meningococcal

27
Q

Echinococcus granulosus vs Entamoeba histolytica

A

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
Q

how does oral estrogen therapy affect thyroid hormones?

A

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
Q

what drugs decrease levothyroxine absorption

A

cholestyramine, iron, calcium, aluminum hydroxide, PPIs, sulcralfate

30
Q

what drugs ^TBG concentration

A

estrogen, tamoxifen, raloxifene, heroin, methadone

31
Q

what drugs decrease TBG concentration

A

androgens, steroids, nicotinic acid

32
Q

what drugs ^thyroid hormone metabolism

A

rifampin, phenytoin, carbamazepine, phenobarbital

33
Q

dyspnea, tachypnea, tachycardia, hypoxia worsened with IVF + patchy irregular alveolar infiltrates on CXR, think ?

A

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
Q

info to include on signout

A

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
Q

eye probs: horldeoum vs chalazion vs dacryocystitis

A

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
Q 
infective endocarditis etiology associations
S. aureus:
Viridans:
S. epidermidis:
Enterococci:
S. bovis:
Fungi (Candida):
A

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
Q

screening for bladder cancer?

A

USPSTF recommends AGAINST screening for bladder cancer due to low incidence and poor positive predictive value of screening tests

38
Q

most effective for reducing HTN

A

weight loss
then DASH, Na restriction, exercise, etOH reduction
smoking inconclusive but recommended

39
Q

what therapy for managing bone pain in patients with prostate cancer AFTER androgen ablations (orchiectomy)

A

radiation, focal external beam is a good choice

40
Q

goal PaO2 when ventilating to prevent ARDS

why?

A

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
Q

what to give if homocysteinemia

A 
vitamin B6 (pyridoxine)
lowers homocysteine levels by acting as a cofactor for enzyme cystathionine B-synthase, which metabolizes homocysteine to cystathionine
42
Q

best imaging for ureteral/kidney stones

A

Ultrasound or noncontrast spiral CT

43
Q

hypopituitarism will lead to what levels of

free T4, cortisol, and aldosterone?

A

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
Q

isolated thrombocytopenia think ?

and get what tests?

A

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
Q

+VDRL, prolonged PTT, thrombocytopenia, think?

A

antiphospholipid antibody syndrome, ppx with low dose ASA and LMWH to prevent pregnancy loss in pregnant females

46
Q

RV failure, tachycardic, hypotensive, ^JVD, consider

A

massive PE

47
Q

fever and sore throat in pt taking antithyroid drug suggests?

A

agranulocytosis

48
Q

CSF with ^lymphocytes, ^RBCs, ^protein

A

HSV encephalitis

dx with HSV PCR

49
Q

how to tx pseudotumor cerebri?

complication of untx?

A

weight reduction, acetazolamide

blindness! use shunting or optic nerve sheath fenestration to prevent

50
Q

pt with HA, n/v, abdominal pain, confusion, tachycardia, tachypnea, and pinkish-skin hue think ?

A

carbon monoxide poisoning

51
Q

exposure to burning rubber or plastic, bitter almond breath, think ?

A

cyanide poisoning

52
Q

cyanosis and bluish discoloration of skin and mucous membranes, think ?

A

methemoglobinemia

53
Q

when to use hinged knee braces vs knee immobilizers

A

hinged: prevention and treatment of ligamentous injuries
immobilizer: patellar fractures or tears of quads or patellar tendon

54
Q

SEs of cyclosporine

A

nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, tremor

55
Q

tacrolimus SEs

A

nephrotoxicity, hyperkalemia, HTN, tremor

56
Q

azathioprine SEs

A

dose-related diarrhea, leukopenia, hepatotoxicity

57
Q

mycophenolate SEs

A

BM suppression

58
Q

what is haptoglobin? elevated or decreased in hemolytic anemia?

A

protein that binds free Hbg to form Hgb-haptoglobin complexes that are easily removed by the liver
haptoglobin DECREASED in hemolytic anemia

59
Q

AFP is elevated in ?

A

testicular germ cell tumors and hepatocelluare carcinoma

IM Uworld (16 decks)

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