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Internal Medicine Shelf > UWorld 1 > Flashcards

UWorld 1 Flashcards

1
Q

In wide-complex tachycardia, what signs distinguish unstable patients from stable? What are the treatments of each?

A

Unstable signs: Altered mental status, hypotension, respiratory distress

Treatment for stable: IV amiodarone

Tx for unstable: Synchronized cardioversion

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2
Q

What are the three categories of hypercalcemia? What is the treatment for each?

A

Severe: 14+ mg/dL
Tx: Immediate IV NS and calcitonin, avoid loop diuretics unless volume overload/heart failure, (Calcitonin inhibits osteoclast-mediated bone resorption)
Long term bisphosphonate

Moderate: 12-14 mg/dL
Tx: No immediate tx unless symptomatic (IV NS, -loops), long term bisphosphonates

Mild or asymptomatic: 12- mg/dL
Tx: No immediate treatment. Long term avoid thiazide diuretics, lithium, volume depletion and prolonged bed rest. (Assumably all lead to dehydration)

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3
Q

What are the top five lifestyle modifications that have the greatest impact on blood pressure, in descending order?

A 
Weight loss (5-20 decrease per 10kg loss)
DASH diet (8-14)
Exercise (4-9)
Salt Restriction (2-8)
Alcohol cessation (2-4)
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4
Q

What are the CBC and other lab findings of CML?

A

Leukocyte count very high (often over 100,000, but not always)
BCR-ABL fusion
Leukocyte alkaline phosphatase Low (marker of neutrophil activity, elevated in leukemia reaction/infection)
Neutrophil precursors less mature: more Myelocytes than metamyelocytes
Absolute basophil count elevated (Basophilia)

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5
Q

What does the leukocyte alkaline phosphatase measure?

A

Neutrophil activity. An increased LAP occurs in infections/leukemoid reactions where neutrophil activity is expected to increase to fight the infection.

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6
Q

What are the gross and microscopic findings in UC and Crohn’s disease?

A

Gross: UC shows mucosal and submucosal inflammation with pseudo polyps. Crohn’s shows transmural inflammation, linear mucosal ulceration, cobblestoning, and creeping fat.

Microscopic: UC has no granulomas, Crohn’s has non-caseating granulomas.

UC may also cause toxic megacolon
Crohn’s never occurs in the rectum, but may show perianal involvement.

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7
Q

What is the MOA of adenosine?

A

Adenosine blocks L-type calcium channels, decreasing conduction in the AV node. This can lead to a transient AV nodal block and stop AV-node dependent re-entry tachycardia. Great for stopping SVT, completely contraindicated in second or third degree AV block.

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8
Q

How do Beta-blockers slow heart rate? Digoxin?

A

Both B-bloickers and digoxin delay AV node conduction, which may cause or worsen AV blocks. Totally contraindicated in complete heart block.

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9
Q

Signs and symptoms of Parvovirus B19 infection?

A

Most patients are asymptomatic or have flu-like illness
Erythema infectiosum (slapped cheeks/fifths disease): fever, nausea, and rash (most common in children)
Acute, symmetric arthralgias/arthritis: hands, wrists, knees and feet (resembles RA)
Transient red cell aplasia: aplastic crisis in patients with underlying hematologic disease (sickle cell, thalasemmia)

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10
Q

Diagnostic tests of Parvovirus B19?

A

Acute infection:

  • B19 IgM antibodies in immunocompetent
  • NAAT for B19 DNA in immunocompromised

B19 IgG indicated previous infection and immunity
Reactivation of previous infection shows +NAAT B19 DNA

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11
Q

Viruses that cause retinitis and blindness in AIDS patients? How to differentiate?

A

CMV - most common cause of retinitis
HSV - most common cause of corneal blindness
VZV - also causes intra-ocular inflammation

CMV, though the most common serious ocular complication in HIV patients, causes a PAINLESS inflammation and does not cause conjunctivitis or keratitis. Fundoscopy shows fluffy or granular lesions near the retinal vessels, w/ hemorrhages.

HSV - Initial symptoms are PAINFUL (think usual herpes sores) conjunctivitis and keratitis. Rapidly progressing bilateral necrotizing retinitis.

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12
Q

Symptoms of renal artery stenosis?

A

Resistant HTN,
Malignant HTN,
Onset of severe HTN (over 180/120) after age 55
Sever HTN with diffuse atherosclerosis
Recurrent flash pulmonary edema with severe HTN

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13
Q

Lab, imagine and exam findings in renal artery stenosis?

A

PE: Asymetric renal size (over 1.5cm), abdominal bruit

Labs: Unexplained rise in serum creatinine (over 30%) after starting ACEi or ARB

Imaging: Unexplained atrophic kidney

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14
Q

Eyes involved, “stuck shut” sensation in mornings, discharge, patient complaints, and conjunctival appearance of allergic conjunctivitis?

A

Bilateral eyes
Feel stuck shut in mornings
Watery, scant stringy mucous discharge
Discharge does not reappear after wiping
Patient complains of itching and history of allergy
Conjunctivae appear diffusely injected, follicular or bumpy, conjunctival edema

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15
Q

Viral vs bacterial conjunctivitis?

A

Both unilateral, both feel stuck shut in mornings
Bacterial produces thick, purulent, discolored discharge that reappears after wiping
Viral discharge is watery with scant stringy mucus
Viral feels sandy, gritty, or burning/viral prodrome
Viral conjunctivae appear like allergic, follicular or “bumpy”
Bacterial also appear diffusely injected, but non-follicular

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16
Q

Basic signs of alzheimer’s disease

A

Early insidious short term memory loss
Language deficits and spatial disorientation
Later personality changes

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17
Q

Vascular dementia

A

Stepwise decline
Early executive dysfunction
Cerebral infarction and/or deep white matter changes on MRI

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18
Q

Frontotemporal dementia

A

Early personality changes
Apathy, disinhibition, and compulsive behavior
Frontotemporal atrophy on neuroimaging

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19
Q

Dementia with Lewy Bodies

A

Visual hallucinations
Spontaneous parkinsonism
Fluctuating cognition

20
Q

Normal-pressure hydrocephalus

A

Ataxia early in disease
Urinary incontinence
Dilated ventricles on neuroimaging

21
Q

Prion disease

A

Behavioral changes
Rapid progression
Myoclonus and or seizures

22
Q

Spectrum of amoxicillin-clavulanate and some uses?

A

Gram positive, gram negative and beta-lactamase-producing anaerobes. Good for oral injuries or bite wounds, also treatment resistant otitis media

23
Q

Spectrum of ampicillin and some uses? Not covered?

A

Gram positive and gram negative, but no beta-lactamase-producing organisms. Upper respiratory tract infections, eg pharyngitis

24
Q

Spectrum and uses of ciprofloxacin? Not covered?

A

Gram negative and some gram positive (except streptococci). Does NOT cover anaerobes. Useful for genitourinary and gastrointestinal infections.

25
Q

Spectrum and uses of clindamycin? Not covered?

A

Gram positive and anaerobes. NOT gram-negative.
Lung abscesses
Skin and soft tissue infections
Female upper reproductive tract infections

26
Q

Spectrum and uses of erythromycin? Spectrum not covered?

A

Second line agent in chlamydial and gonococcal infections

Some atypical organisms, but little gram negative or anaerobic coverage

27
Q

Most common predisposing conditions for aspiration pneumonia, in descending order?

A

Altered consciousness impairing cough reflex/glottic closure (Dementia, intoxication)
Dysphagia due to neurologic deficits (stroke, near disease)
Upper GI disorders (GERD)
Mechanical compromise of aspiration defenses (nasogastric tube, ET tube)
Protracted vomiting
Large volume tube feeding in recumbent position

28
Q

Metformin: Percentage decrease in A1C, effects on weight, hypoglycemia, other concerns?

A

A1C: 1-2%
Weight neutral
Low risk of hypoglycemia
Lactic acidosis

29
Q

Sulfonylureas: Percentage decrease in A1C, effects on weight, hypoglycemia?

A

A1C: 1-2%
Generally used in patients with metformin failure
Weight gain
May cause hypoglycemia

30
Q

Thiazolidinediones (Pioglitazone): A1C reduction, used when? Side effects? Hypoglycemia?

A

A1C: 1-1.5%
Used if unable to tolerate metformin or sulfonyureas
Also can be used in renal insufficiency
SE: Weight gain, edema, CHF, bone fracture, bladder cancer
Low risk of hypoglycemia

31
Q

DPP-4 inhibitors (sitagliptin): A1C reduction, when used? Weight effect? Hypoglycemia?

A

A1C: 0.5-0.8%
Can be used in renal insufficiency
Weight neutral
Low risk of hypoglycemia

32
Q

GLP-1 receptor agonists (exenatide): A1C reduction, when used? weight effect, hypoglycemia?

A

A1C: 0.5-1%
Second agent for metformin failure
Weight loss (only agent that induces weight loss)
Low hypoglycemia risk when used alone or with meformin

33
Q

Clinical manifestations of granulomatosis with polyangiitis?

A

Upper respiratory: Sinusitis/otitis, saddle-nose deformity
Lower respiratory: Lung nodules/cavitation
Renal: Rapidly progressive GN
Skin: Lived reticularis, non healing ulcers

34
Q

Diagnosis and management of granulomatosis with polyangiitis?

A

ANCA: PR3 (70%) or MPO (20%)
Biopsy: skin, lung, kidney
Management: Corticosteroids, immunomodulators (MTX, cyclophosphamide)

35
Q

Multiple myeloma: Disease process and complications?

A

Monoclonal neoplastic infiltration of bone marrow alters and impairs the normal lymphocyte population, resulting in ineffective antibody production. Hypogammaglobulinemia impair immune function and allows increased infections, esp respiratory (S pneumo) and urinary tract infections.

Bone marrow infiltration also causes osteoclast activation leading to osteolytic lesions and fractures, hypercalcemia, and anemia. Overproduction of monoclonal proteins can clog renal tubules, resulting in renal insufficiency.

36
Q

Thrombotic thrombocytopenia purpura presentation?

A 
Thrombocytopenia
Microangiopathic hemolytic anemia
Renal insufficiency
Neurologic changes
Fever

Deficiency of ADAMTS13 leads to long chains of vW factor on the endothelial wall, causing the collection of platelets which then damage the passing blood cells.

37
Q

Presentation of angioedema?

A

Edema in the face, mouth, lips, tongue, glottis, pharynx, and preorbital area. May cause airway obstruction.
ACE is also known as kininase because it brakes down bradykinin. ACE inhibitors cause an increase in bradykinin, which then causes inflammation and edema.

38
Q

Etiologies of SIADH

A

CNS disturbance (stroke, hemorrhage, trauma)
Medications (carbamazepine, SSRI, NSAIDs)
Lung disease (pneumonia)
Ectopic ADH secretion (small cell lung cancer)
Pain and or nausea

39
Q

Erysipelas vs cellulitis: difference in appearance?

A

Erysipelas infects the superficial dermis and lymphatics, causing a raised area of inflammation with sharp edges. It has a rapid spread and early fever.

Cellulitis infects the deep dermis and subcutaneous fat, has flat edges and poor demarcation, spreads slowly over days (indolent), and doesn’t have a fever until later in the course.

Purulent cellulitis produces purulent drainage, folliculitis, furuncles (abscesses from folliculitis), and carbuncles (multiple furuncles).

40
Q

Coccidioides presentation

A 
Endemic to southwestern deserts 
Community acquired pneumonia
Arthralgia
Erythema nodosum
Erythema multiforme
Also called gallery fever, lasts weeks or months

Mild cases are not treated. Severe cases or patients who are immunocompromised or have DM require antifungals (ketoconazole, fluconazole)

41
Q

Blastomyces dermatitidis location and presentation

A

Central and midwestern states.
Acute or chronic pneumonia
skin lesions are common but not always present

42
Q

Signs of back pain from metastatic disease

A 
History of malignancy
Age over 50
Worse at night
Unintentional weight loss
Cauda equina syndrome (weakness, urine retention/incontinence, saddle anesthesia)
43
Q

Presentation of Paget’s disease?

A

Most patients are asymptomatic
Bone pain and deformity
- Skull: headache and hearing loss
- Spine: Spinal stenosis and radiculopathy
- Long bones: Bowing, fracture, arthritis of adjacent joints
Giant cell tumor, osteosarcoma

44
Q

Pathogenesis and lab tests for Paget’s disease?

A

Osteoclast dysfunction, increased bone turnover

Elevated Alk Phos, elevated bone turnover markers (PINP, urine hydroxyproline), NORMAL calcium and phosphate

45
Q

Imaging and Treatment of Pagets?

A

Osteolytic or mixed lytic/sclerotic lesions
Bone scan shows focal increase in uptake

Tx: Bisphosphonates

Internal Medicine Shelf (3 decks)

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