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Internal Medicine > Random UWorld Questions > Flashcards

Random UWorld Questions Flashcards

1
Q

Dx: fever, recent cruise, SOB, confusion, relative brady (given fever), hyponatremia, transaminitis, hematuria and/or proteinuria

A

think legionella (check Urine antigen test)

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2
Q

tx for legionella

A

macrolide or FQ

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3
Q

Examples of viridans strep species?

A

S. mutans, S. mitis, S. milleri, S. oralis, S. sobrinus and S. sanguinis

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4
Q

S. bovis bacteremia, think?

A

Inf endocarditis d/t colon cancer or IBD lesion (specifically S. bovis biotype 1 a.k.a. S. gallolyticus)

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5
Q

Causes of a LOW anion gap?

A

re-call that AG = unmeasured anions - unmeasured cation, so LOW anion gap means HIGH unmeasured cations (e.g. Ca, Mg, K, Li, bromine or Igs OR low albumin -> decr binding sites for cations)

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6
Q

Initial work-up for metabolic acidosis?

A
  1. Check anion gap
    2a. If incr Gap -> calc ∆∆, OG Gap, check ketonuria
    ∆∆ = (∆AG/∆HCO3) | ∆AG = (calc AG - measured AG)
    ∆HCO3 = (24 - HCO3)
    ∆∆ = 1-2 then pure AG metab acidosis
    ∆∆ 2 then AG metab acidosis PLUS metab ALKalosis
    —OG Gap (measured SOsm - calc’d SOsm)
    Calc’d Osm = 2Na + gluc/18 + BUN/2.8
    OG > 10 -> ingestion likely
    2b. If Non-Gap -> check UAG = [(U_Na +U_K) - U_Cl]
    —negative UAG -> appropriate renal NH4+ excretion
    ——DDx: GI causes, proximal RTA, early renal fail
    —positive UAG -> failure of kidneys to excrete NH4+
    ——DDx: distal (low serum K+) of hypoaldo RTA (high serum K+) or early renal failure
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7
Q

Kussmaul’s sign and its association

A

JVP fails to decrease or actually increases during inspiration (paradoxical behavior); associated with constrictive cardiac issues (e.g. constrictive pericarditis)

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8
Q

Diamond Criteria for CP

A
  1. L-sided chest pain
  2. worse w/ exercise
  3. at least some relief w/ rest + NTG
    —ALL 3 = typical, 2 = atypical, 0-1 = non-anginal
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9
Q

anti-pseudomonal abx by class

A

penicillins (pip, ticaracilin), cephalosporins (ceftazidime [3rd], cefipime [4th]), AGs (gent, tobra, amikacin), FQs (cipro and levo), monobactams (aztreonam), and carbopenems (mero- and imipenem)

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10
Q

drugs that cause folic acid deficiency

A

some AEDs (phenytoin, primidone, phenobarb), TMP/SMX, and MTX

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11
Q

isoniazid causes what vitamin deficiency?

A

b6

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12
Q

classic physical exam findings for cardiac tamponade?

A

Beck’s Triad: hypotension, JVD and muffled heart sounds (in a non-obese pt)

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13
Q

Absolute contra-indications to combined hormonal OCPs

A 
migraine w/ aura
Stage II HTN (BP > 160/100)
Smoke >15 cigs/d & 35+ y/o
H/o VTE
H/o stroke or ischemic heart dz
Breast cancer
Cirrhosis/liver cancer
Surgery w/ prolonged immobilization
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14
Q

Erythema nodosum is most common in ___ and if not primary can be a warning sign of ____?

A

women 15-40 y/o; relatively benign and heals on its own in a few weeks
—most commonly due to recent strep infection (culture) or sarcoidosis in black women (get CXR)
—TB, histoplasmosis, or IBD

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15
Q

Most common HIV-associated kidney disease?

A

focal and segmental GN (a.k.a. HIV-nephropathy); occurs even in pts on tx despite normal CD4 count; more common in blacks for unknown reason

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16
Q

S4

A

“TEN-nes…see”; (S4-S1…s2) signifies stiffened LV c/w diastolic HF; due to the artial kick at the end of diastole “kicking” the residual blood from the LA onto a stiffened LV

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17
Q

MEN 1

A

[P]rimary hyperPTH (>90%), [P]ancreatic/upper GI (60-70%), [P]ituitary adenomas (10-20%)
- Panc/UGI: gastrinoma, insulinoma, VIPoma (diarrhea, hpyoK, hypoCl), glucagonoma (hyperGLY, necrolytic migratory erythema

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18
Q

Milk alkali presentation

A

hypercalcemia, decreased renal function, metab alkalosis

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19
Q

top 3 cancers that met to the liver

A

breast, lung and GI

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20
Q

Indications in CEA for men vs. women

A

Women: cut when occlusion > 70% regardless of sx
Men: w/ sx cut > 50%, w/o cut >60%

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21
Q

Equation for NNT = ?

A

NNT = 1/ARR, where ARR = Incidence (grp 1) - Incidence (grp 2)

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22
Q

Pathophys of hyperoxaluria leading to stones?

A

Starts w/ poor lipid absorption in gut -> Calcium binds lipids instead of their usual habit of binding to oxalte -> Oxalate is no longer bound to calcium and can therefore be absorbed.

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23
Q

Light’s Criteria for Pleural Fluid Analysis

A

Exudate if

  • fluid_prot : serum_prot > 0.5 OR…
  • fluid_LDH : serum_LDH > 0.6 OR…
  • fluid_LDH > 2/3 ULN for serum
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24
Q

Causes of hyperthyroidism w/ low radio-iodine uptake?

A

In decreasing order of commonness:

  1. subacute, painless thyroiditis
  2. granulomatous (deQuervain’s) painful thyroiditis
  3. iodine-induced thyrotoxicosis
  4. levoTHY o/d
  5. pigs flying
  6. struma ovarii
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25
Q

Tx for CLL?

A

chlorambucil and prednisone

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26
Q

Tx for NHL?

A

CHOP: [C]yclophosphamide, [H]ydroxydanurubicin, [O]ncovin (vincristine), [P]rednisone

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27
Q

Tx for hairy cell leukemia?

A

Cladribine

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28
Q

Tx for thyroid storm?

A
  1. B-blocker
  2. PTU –1hr–> iodine (stop synth of new thyroxine)
  3. glucocorticoids: stop periph T4->T3 conversion
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29
Q

B-blocker toxicity, s/sx? Tx?

A

AV block, brady, hypoTN, WHEEZING (unique vs. CCBs); Tx w/ IV glucagon

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30
Q

Digoxin toxicity

A

GI: anorex/n/v/abd-pain
Neuro: COLOR DISTURBances, weak/fatigue/confused

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31
Q

Imaging test to do when you suspect myasthenia gravis?

A

CT chest: look for thymoma (present in 15% of these pts)

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32
Q

Criteria for admitting pt w/ PNA?

A 
CURB-65
Confusion
Uremia (BUN >20)
Resp rate >30
BP
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33
Q

WBC in joint fluid?

A

0-200/mL - normal
2000-50000/mL - inflammatory
>50,000/mL - septic arthritis

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34
Q

Time cut-off for alteplase in presumed embolic stroke?

A

Must be given within 3-4.5 hours of sx onset

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35
Q

anti-platelet for stroke pt not on any anti-plt?

A

ASA

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36
Q

anti-platelet for stroke pt on ASA?

A

ASA + dipyridamole OR clopidogrel

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37
Q

anti-platelet for stroke pt w/ large vessel intracranial atherosclerosis

A

warfarin, dabigatran, rivaroxaban

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38
Q

attributable risk percentage (ARP) = ?

A

(RR - 1)/RR

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39
Q

6 classic criteria for OA as cause of knee pain

A 
Specificity 69% for 3+ of:
1. > 50 y/o
2. crepitus
3. bony enlargement
4. bony tenderness
5. lack of warmth
6, lack of morning stiffness
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40
Q

Definition of orthostasis?

A

Appropriate reflex tachy PLUS SBP drop >20 OR DBP drop > 10 after 3mins

41
Q

Tx TCA poisoning

A

Oral charcoal if past 2 hours, sodium bicarb for QRS prolongation

42
Q

Enzyme to check when concerned for recurrent MI in the days following original MI?

A

CK-MB b/c it normalizes in 1-2 days vs. Troponin T which takes 10 days to come down.

43
Q

Name other heritable hypercoag states besides Factor V Leiden?

A

Protein C or S deficiencies, antithrombin III deficiency, plasminogen d/o

44
Q

Most common cause of nephrotic syndrome in patients with solid tumors?

A

membranous GN

45
Q

Nephrotic syn assoc’d w/ Hodgkins lymphoma?

A

minimal change disease

46
Q

Nephrotic syn assoc’d w/ URI?

A

IgA nephropathy

47
Q

Amyloid kidney disease is assoc’d w/ which malig?

A

multiple myeloma causing amyloid nephrotic syndrome

48
Q

Pressure measurement to dx pHTN?

A

Pulm art. pressure > 25mmHg at rest of >30 mmHg w/ exercise

49
Q

Causes of avascular necrosis of the femoral head in adults?

A

long-term corticosteroid use, hemoglobinopathies, EtOHism

50
Q

Wells’ Criteria for PE?

A 
Clinical S/Sx of DVT (3)
No other dx as likely (3)
Immob 3d or surg in past 1m (1.5)
HR > 100 (1.5)
Prior PE/DVT (1.5)
Hemoptysis (1)
Malig tx'd in last 6m (1)
51
Q

Metal most likely to cause contact dermatitis (a Type IV hypersensitivity)?

A

nickel

52
Q

Most common mutation seen in PV pts?

A

JAK2-V617F

53
Q

Lone focal neuro finding you can seen IIH (pseudotumor cerebri)?

A

CN VI (abducens n.) palsy

54
Q

Most feared complication of anti-thyroid medications?

A

Both methimazole and PTU can cause agranulocytosis. If pt on these meds comes in w/ fever and sore throat, start broad-spectrum antibiotics w/ pseudomonal coverage.

55
Q

thrombocytopenia and hemolytic anemia w/ no apparent cause?

A

Like TTP, get periph smear (expect schistocytes) and start empiric plasma exchange. Underlying cause is ADAMTS13 protease deficiency. Most cases idiopathic or drug-related, but assoc’d w/ HIV, too.

56
Q

study method to determine prevalence vs. study method to determine incidence?

A

prevalence: cross sectional study
incidence: cohort study (either retro- or pro-spective)

57
Q

Stats test to compare two proportions?

A

chi-square test

58
Q

Stats test to compare two means?

A

two sample t-test (done on means from a sample) or z-test (done on means from a population)

59
Q

Early onset Alzheimer’s is associated with?

A

Trisomy 21

60
Q

Name for infection of the lacrimal sac?

A

dacryocystitis (usually S. aureus or b-hemolytic Strep)

61
Q

chalazion vs. hordeolum

A

hordeolum = painful infection (usu S. aureus); chalazion = painless, chronic, granulomatous inflammation of a meibomian gland

62
Q

Treatment for neuroleptic malignant syndrome?

A

1st line - dantrolene

other options: bromocriptine (dopa-antagonist), amantadine (antiviral w/ anti-dopaminergic properties)

63
Q

Hemophilia A pathophys? Inheritance pattern? Dx?

A

Factor VIII deficiency (X-linked recessive); prolonged aPtt

64
Q

Hemophilia B pathophys? Inhertiance pattern? Dx?

A

Factor IX deficiency (X-linked recessive); prolonged aPTT

65
Q

Anticholinergic overdose mnemonic

A

“hot as a hare” “blind as a bat” (acute glaucoma) “dry as a bone” “red as a beet” “mad as a hatter” “full as a flask”

66
Q

selegiline MoA?

A

MAO-B inhibitor for Parkinson’s; can cause serotonin syndrome when co-administered with SSRIs or TCAs

67
Q

bromocriptine MoA?

A

dopamine agonist used in tx of Parkinson’s, pituitary tumors, neuroleptic malignant syndrome and hyperprolactinemia

68
Q

trihexyphenidyl MoA?

A

anticholinergic for tx of PD or EPS side effects

69
Q

Advanced sleep phase disorder?

A

[A]dvanced = Uncle [A]l (can’t stay awake until after 7-8pm and then wake up early)

70
Q

Delayed sleep phase?

A

Gui (can’t fall asleep until 4-5a, but can sleep normal 8 hrs if able to)

71
Q

At what diameter would you biopsy asymptomatic cervical rubbery nodes?

A

> 2 cm, sooner if pt developed systemic sx

72
Q

normal liver span?

A

6-12 cm in MCL

73
Q

triad of granulomatosis with polyangitis? test?

A

a.k.a. Wegener’s Granulomatosis: present with GN, lower and upper airways granulomatous inflammation and vasculitis | can see nasal bridge destruction, pyoderma gangrenosum | Positive C-ANCA

74
Q

DDx of normotensive pt w/ hypokalemia and alkalosis

A
  1. surruptitious vomiting
  2. Diuretic abuse
  3. Bartter syndrome (resembles loop diuretic use)
  4. Gitelman’s syndrome (resembles thiazide use)
75
Q

Five Hs and Five Ts of reversible causes of PEA?

A

Hs: hypoxia, hypovolemia, hypo/hyperkalemia, hypothermia, hydrogen ions (acidosis)
Ts: TNX, tamponade, toxins (narcs, benzos), thrombosis (PE, MI), trauma

76
Q

False positive VDRL in pregnancy

A

think APS and treat w/ heparin

77
Q

B12 vs. Folate deficiency

A

Both cause megaloblastic anemia, but only B12 causes neuro sx, so important to know which it is before treating.
—B12 will have elevated homocysteine AND methylmalonic acid vs. Folate is homo only (B12 is “bi” symptoms and “bi” test results)

78
Q

Tx and prophylaxis for cluster headaches?

A

Tx: subQ sumatriptan and oxygen
PPx: ergotamines, lithium, and/or verapamil

79
Q

Presentation of cluster HAs

A

sudden onset of severe retrorbital HA in males assoc’d w/ ipsilateral Horner’s syndrome

80
Q

Action of aldosterone

A

[s]aves [s]odium, wastes K+ and H+ (causing metabolic alkalosis)

81
Q

Lambert-Eaton is most commonly associated with?

A

Small Cell Lung Cancer (abs against presynaptic, voltage-gated calcium channels)

82
Q

technical name for PCP?

A

phencyclidine

83
Q

right-sided systolic murmur increases w/ inspiration?

A

TR (as in IVDU endocarditis patients)

84
Q

MRI finding in Huntington’s?

A

atrophy of the caudate nuclei (shows up as widened lateral ventricles)

85
Q

dex for meningitis due to which pathogen? how many days?

A

s pneumo only; 4 days; d/c if other bug comes back

86
Q

Rx to alkalinize urine in uric acid stone pt?

A

potassium citrate

87
Q

Two most common causes of nephrotic syndrome in adults w/o other systemic illness?

A

focal-segmental glomerulosclerosis and membranous nephropathy

88
Q

Give one instance where RBC count matters

A

In differentiating between iron-def anemia and alpha- or beta-thalassemia minor:

  • Fe-def RBCs - low
  • thalassemias minor - normal
89
Q

Mnemonic for eosinophilia?

A

NAACP: [N]eoplasm, [A]ddison’s (panhypopit, etc.), [A]llergy, [C]ollagen Vasc Dz/[C]holesterol emboli, [P]arasites

90
Q

NF-II?

A

café-au-lait spots and (?unilateral) acoustic neuromas

91
Q

Meds that cause hyperK+ and their mechanisms?

A
  1. non-selective BBs (block B2-mediated cell K+ uptake)
  2. ACE/ARBs and K-sparing diurectis (aldo/ENac)
  3. Dig (interrupts Na-K-ATPase)
  4. cyclosporine (blocks aldo activity)
  5. heparin (blocks aldo production)
  6. NSAIDs (decr renal perfusions -> decr K deliv to CDs)
  7. succhinylcholine (K+ leak from AChR’s)
92
Q

PBC Ab?

A

anti-mitochondrial

93
Q

drugs that cause drug-induced esophagitis?

A

ASA/NSAIDs; KCl, Fe, quinidine; tetracyclines; alendronate

94
Q

HIV opp infxs by CD4 count? PPx Rx?

A
95
Q

Mechanism by which EtOH exacerbates gout?

A

EtOH -> lactacte -> competes for urate excretion in the kindey -> incr serum [urate] -> joint accumulation -> flair

96
Q

Which vitamin deficiency causes Wernicke’s encephalopathy? Typical sx?

A

thiamine (B1) [ ¡NOT COBALAMIN (B12)! ] B12 does cause peripheral neuropathy, but not Wernicke’s sx of: ophthalmoplegia, ataxia, confusion

97
Q

Low back pain red flags? Work-up

A

> 50 y/o, h/o malig, trauma, no imprvmnt 1 mo, night-time pain/wakens from sleep, neuro sx, constitutional sx, IVDU
—If pt has these + cord compression sx -> MRI
—If no cord compression sx -> plain XR w/ ESR
—If none of these, observe 4-6wks NSAIDs/PT

98
Q

SAAG interpretation?

A

> 1.1 g/dL - likely d/t portal HTN

99
Q

neutrophil count in ascitic tap to be c/w SBP?

A

> 250/uL

Internal Medicine (6 decks)

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