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Internal Medicine > Uworld > Flashcards

Uworld Flashcards

1
Q

Osteomalacia causes?

A

malabsorption, intestinal bypass surgery, celiac sprue, chronic liver or kidney disease

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2
Q

bone resorption markers?

A

c-telopeptide & n-telopeptide

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3
Q

bone formation markers?

A

alkaline phosphatase & osteocalcin

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4
Q

osteomalacia?

A

def: defective bone mineralization due to vitamin D deficiency
px: hypophosphatemia + hypoCa + elevated alk phos

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5
Q

metabolic compensation for respiratory alkalosis =

A

2 mEq/L of HCO3 for every 10 mmHg change in PaCO2

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6
Q

Winter’s formula?

A

Arterial PaCO2 = 1.5(HCO3) + 8 +/- 2

-estimates respiratory compensation in primary metabolic acidosis

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7
Q

ASA intoxication –>

A

mixed respiratory alkalosis & metabolic acidosis

resp alk: increase respiratory drive from medullary respiratory center

metabolic acidosis: increased production/ decreased renal elimination of lactic/ ketoacids

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8
Q

multiple myeloma

A

CRAB
hyperCa + renal impairment + anemia + bone pain (lytic lesions, fractures)

  • inc risk for infection
  • leukopenia
  • inc total protein from paraproteins
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9
Q

infectious mononucleosis

A

fever + lymphadenopathy + pharygitis

cause: EBV
dx: heterophile Ab (monospot test) –> EBV-specific Ab (if heterophile test neg)

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10
Q

mucormycosis

A

fungal infection

agent: Rhizopus species
cause: poorly controlled DB

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11
Q

actinomyces

A
  • anaerobic, gram+, filamentous branching bacteria
  • oral cavity
  • sulfur granules –> yellow granular pus

-tx: high dose penicillin for prolonged period (12 weeks)

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12
Q

what treatment limits ventricular remodeling after a MI?

A

ACEI

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13
Q

diabetic neuropathy tx?

A

TCAs (amytriptyline, desipramine, nortriptyline)
Gabapentin
NSAIDs

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14
Q

HITT

A
  • heparin-induced thrombocytopenia & thrombosis
  • paradoxical pro-thrombotic state
  • autoimmune –> skin necrosis & hemorrhage
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15
Q

vitamin K paradoxical pro-coagulant effects?

A

occur in first few days of treatment due to inhibition of protein c (which has a shorter half life than factors 2, 7, 9, 10)

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16
Q

extrapulmonary sites for TB

A

liver, spleen, kidney, bone, adrenal gland

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17
Q

signs of adrenal insufficiency

A

hyperkalemia, hypoglycemia, eosiniphilia

causes: histoplasmosis, coccidiodomycosis, cryptococcosis, sarcoidosis

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18
Q

Indications for aortic valve replacement?

A

1) symptomatic pts with AS
2) pts with severe AS undergoing CABG or other valvular surgery
3) asymptomatic pts with severe AS & either poor LV systolic functions, LV hypertrophy >15mm, valve area <0.6cm2, or abnormal response to exercise

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19
Q

primary biliary cirrhosis marker and tx?

A

marker: anti-mitochondiral antibodies

tx: ursodeoxycholic acid
- methotrexate & colchicine have moderate benefit
- liver transplantation for advanced disease

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20
Q

giant cell arteritis symptoms?

A

px: headache, jaw claudication, muscle fatigue, visual disturbance
complications: aortic aneurysm

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21
Q

causes of pancreatitis?

A
  • cholelithiasis (stones)
  • hyperTG
  • ethanol use
  • medication (thiazides)
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22
Q

Haldane effect

A

DeO2-blood has an increased ability to carry CO2

O2-blood has a decreased ability to carry CO2

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23
Q

side effects of beta-2 agonists

A

hypoK, tremor, palpitation, headache

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24
Q

hyperthyroid px

A

anxiety, insomnia, palpitations, heat intolerance, perspiration, weight loss without dec appetite

goiter, HTN, tremors, hyperreflexia, proximal muscle weakness, lid lag, a. fib

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25
Q

chronic HCV

A

-waxing & waning elevations of ALT & AST

  • mixed cryoglobulinemia
  • porphyria cutanea tarda
  • membranoproliferative glomerulonephritis
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26
Q

what is the mechanism of kidney damage in SLE patients?

A
  • immune complex mediated

- low C3 from complement activation

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27
Q

drugs that cause idiosyncratic reactions?

A

isoniazid, chlorpromazine, halothane, antiretroviral therapy

-NO rash, arthralgias, fever, leukocytosis, or eosinophilia

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28
Q

causes of ARDS?

A
  • impaired gas exchange
  • dec lung compliance
  • pulmonary hypertension
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29
Q

side effects of isoniazid

A

peripheral neuropathy, hepatitis

-give pyridoxine (vit B6) supplement for neuropathy tx

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30
Q

cause of isolated systolic HTN?

A

decreased elasticity of the arterial wall

  • inc risk of CVD event
  • tx: low dose thiazide, ACEI, or long-acting CCB
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31
Q

Factor V Leiden?

A

Factor V becomes resistant to inactivation by protein C –> hypercoaguable state –> DVT

-commonly inherited disorder

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32
Q

PCP (pneumocystis PNA) prophylaxis?

A

TMP-SMX (trimethoprim-sulfamethoxazole)

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33
Q

tx for pericarditis

A

ibuprofen

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34
Q

what is the use-dependance phenomenon in anti arrhythmic medications?

A
  • they are more effective at higher HRs
  • bc there’s not as much time b/t heartbeats for the medication to dissociate from its receptor
  • class IC (Na) and IV (Ca) medications
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35
Q

acute-onset dyspnea + wheezing + prolonged expiration =

A

bronchoconstriction

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36
Q

psoriatic arthritis px?

A

-distal interphalangeal joints

  • morning stiffness
  • deformity
  • dactylitis (“saugsage digit”)
  • nail involvement

-tx: NSAIDs, methotrexate

(RA is usually DIP joints)

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37
Q

what is ARDS?

A

acute respiratory distress syndrome

  • non-cardiogenic pulmonary edema
  • caused by leaky alveolar capillaries

-mechanical ventilation: PEEP and low tidal volumes

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38
Q

what are the causes of ARDS?

A

sepsis, severe infection, severe bleeding, toxins, burns

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39
Q

aliskiren

A

= renin inhibitor

40
Q

3 common causes of cough

A
  • postnasal drip (upper airway cough syndrome)
  • asthma
  • GERD
41
Q

ACEI-induced cough mechanism

A

increased [bradykinin] due to dec degradation of bradykinin–>substance P

42
Q

late px of aortic coarctation

A
  • asymptomatic HTN
  • epistaxis
  • upper extremity HTN, lower extremity hypotension
  • brachial-femoral delay
  • left ventricle hypertrophy (EKG)
  • intercostal artery notching (CXR)
43
Q

side effects of thiazide diuretics

A

Hyper GLUC:

  • hyperGlycemia
  • hyperLipidemia
  • hyperUricemia
  • hyperCalcemia

-hypoNa, hypoK

44
Q

medications that cause hyperK

A
  • nonselective beta blockers
  • ACEI
  • ARB
  • NSAIDs
  • K-sparing diuretics
  • cardiac glycosides (digoxin)
45
Q

causes of hyperK

A
  • medications
  • AKI or CKD
  • acidemia
  • hyperglycemia
  • tumor lysis syndrome

-acute tx: calcium gluconate

46
Q

EKG changes from hyperK

A
  • peaked T waves
  • shorted QT interval
  • QRS widening
47
Q

flail chest

A
  • due to crush injury
  • > 3 adjacent rib fractures that break in 2 places
  • respiratory distress
  • tachypnea with shallow breaths
48
Q

pulsus paradoxus

A

fall in systolic pressure >10 mmHg during inspiration

-causes: cardiac tamponade, asthma, COPD

49
Q

signs of PE

A 
SOB
tachypnea
hypoxemia
tachycardia
pleuritic CP
hemoptysis
low grade fever
hemoptysis
50
Q

Behecet’s syndrome

A

multi-systemic inflammatory condition

recurrent oral ulcers + genital ulcers + skin lesions (erythema nodosum) + uveitis

  • positive pathergy test
  • Asian, Turkish, Middle East populations
51
Q

Reactive arthritis

A

urethritis + conjunctivitis + arthritis

=Reiter’s syndrome

52
Q

endocardial fibroelastosis

A

occurs in first 2 years of life

restrictive cardiomyopathy

53
Q

hereditary hemochromatosis

A

abnormal Fe deposition in various organs –> end-organ damage/failure

increased intestinal Fe absorption

  • cirrhosis + DB + skin pigmentation
  • “bronze DB”
  • elevated liver enzymes
  • hypogonadism (dec libido, testicular atrophy)
  • conduction abnormalities in heart
  • restrictive or dilated cardiomyopathy
54
Q

neuroleptic malignant syndrome px?

A 
mental status change
fever
muscle rigidity
diaphoresis
CK = 50,000

tx:
dantrolene (muscle relaxant)
bromocriptine (dopamine agonist)
amantadine (antiviral with dopaminergic properties)

cause: antipsychotic drugs (dopamine antagonists)

55
Q

common causes of digital clubbing

A
  • lung malignancy
  • cystic fibrosis
  • R–>L cardiac shunts

-NOT from hypoxemia/COPD

56
Q

“fight bite” tx

A

amoxicilling-clavulanate (Augmentin)

=human bite –> polymicrobial coverage needed (gram+, gram-, and anaerobes)

57
Q

SE of floroquinolone

A

tendinopathy or tendon rupture (Achilles most commonly)

  • rotator cugg, hand, biceps, thumb, etc
  • stop drug, avoid exercise
58
Q

renal cell carcinoma

A 
flank pain + hematuria + palpable abdominal mass
LEFT scrotal varicocele
paraneoplastic symptoms (anemia, erythrocytosis, thrombocytosis, fever, hyperCa, cachexia)
59
Q

hyperCa induces?

A

urinary salt wasting
–>volume depletion

tx: saline hydration + bisphosphonates (long term tx)

60
Q

congenital long QT syndrome

A

FH of sudden death
prolonged QT interval
syncope with triggers (exercise, swimming, sudden noise, during sleep)

61
Q

torsades de pointes

A

= acquired long QT syndrome

cause: hypoK, hypoMg

62
Q

methotrexate

A

dihydrofolate reductase inhibitor

DMARD = disease-modifying anti-rheumatic drug

SE: macrocytic anemia, nauseas, stomatitis, rash, hepatotoxicity, interstitial lung disease, alopecia

63
Q

common causes of avascular necrosis of bone (osteonecrosis)?

A

chronic corticosteroid use

chronic excessive alcohol ingestion

64
Q

hereditary spherocytosis

A
  • autosomal dominant
  • lack of spectrin causes RBCs to become spheres –> unable to pass through splenic red pulp –> hemolysis
  • tx: supportive or splenectomy
  • risk of sepsis from encapsulated organisms (Strep pneumo, H flu) >10 yrs
  • vaccinate against pneumococcus, H flu, meningococcus
65
Q

mild asymptomatic hyperCa + inappropriately high-to-normal PTH

A

familial hypocalciuric hypercalcemia

  • low urinary Ca
  • Ca/cr 0.02
66
Q

pericarditis px

A

worsening CP with inspiration, improved leaning forward

diffuse ST elevation
reciprocal depression in avR

tx: NSAIDs; corticosteroids in refractory cases

67
Q

Dressler’s syndrome

A

=pericarditis 1 week after an MI

  • immunologic phenomena
  • tx: NSAIDs
  • avoid anticoagulants to prevent hemorrhagic pericardial effusion
68
Q

symptoms of alcohol withdrawal

A

reflex hyperactivity:

  • anxiety
  • insomnia
  • tremors
  • diaphoresis
  • hallucinations
  • withdrawal seizure
  • delirium tremens
69
Q

what is delirium tremens

A

-result of alcohol withdrawal

HTN + agitation + tachycardia + hallucinations + fever

  • mortality rate up to 5%
  • tx: benzodiazepines (chlordiazepoxide) bc of similar cross-tolerance with alcohol
70
Q

opiod withdrawal px?

A

dilated pupils + piloerection + dysphoria + myalgias + abdominal pain

-tx: methadone (long acting opiod –also for heroin addiction management)

71
Q

lupus arthritis

A
  • MCP & PIP joints

- non deforming (which is how it is differentiated from RA)

72
Q

arthritis in DIP

A

OA (non-inflammatory) & psoriatic arthritis (dactylitis)

73
Q

opiod intoxication

A

respiratory depression
miosis
sedation

74
Q

lithium toxicity

A

tremor
hyperreflexia
ataxia
seizures

75
Q

phenytoin toxicity

A

horizontal nystagmus
cerebellar ataxia
confusion

76
Q

CHADS2

A 
CHF
HTN
Age >75
DB
Stroke hx (2 points, all others 1)
  • measures risk for stroke
  • low (0) – no anticoag or ASA
  • med (1) – anticoag or ASA
  • high (2-6) –anticoag
77
Q

zinc deficiency

A
  • alopecia
  • abnormal taste
  • bullous, pustulous lesions around perioral and periorbital areas

-normally absorbed in jejunum

78
Q

vitamin A deficiency

A

blindness
dry skin
impaired immunity

79
Q

B12 deficiency

A

macrocytic anemia

neurologic symptoms

80
Q

selium deficiency

A

cardiomyopathy

81
Q

trastuzumab

A
  • tx for HER2 breast cancer
  • HER2 gene detected by FISH or immunohistochemical staining

=herceptin

82
Q

DIC

A

thrombocytopenia + thrombosis + bleeding

83
Q

hereditary telangiectasia

A

diffuse telangiectasias + recurrent epistaxis + widespread AV malformations

  • autosomal dominant
  • AVM in mucous membranes, skin, GI, liver, brain lung (–> chronic hypoxemia)
84
Q

chronic bronchitis

A

chronic productive cough for 3 months in 2 successive years

85
Q

anti-pseudomonal agents

A

cefepime
meropenem
piperacillin-tazobactam

86
Q

hypoCa from transfused blood via..

A
  • chelation by citrate anticoagulant
  • chelates Mg, as well
  • ->paresthesias

-stored RBCs can also release K –> hyperK

87
Q

type 4 RTA

A
  • non-anion gap metabolic acidosis
  • aldosterone deficiency/ resistance
  • hyperK & acidosis

-elderly pts with poorly controlled DB

88
Q

loop diuretics cause metabolic______ & hyp___K

A

metabolic alkalosis

hypoK

89
Q

venous thrombosis in what type of nephrotic syndrome?

A

membranous glomerulonephritis

90
Q

3 types of DB retinopathy

A
  • background/simple = microanneurysm, hemorrhage, exudates
  • pre-proliferative = cotton wool spots
  • proliferative/malignant = neovascularization
91
Q

elevated AFP & beta-HCG + mediastinal mass

A

nonseminomatous germ cell tumor

-seminomas only have elevated beta-HCG

92
Q

choriocarcinoma

A
  • elevated beta-HCG
  • associated with molar pregnancy
  • elevated beta-HCG also in seminoma
93
Q

alcoholic hepatitis

A

AST:ALT >2

absolute values of AST & ALT always 25x upper limit = toxin-induced (acetaminophen), ischemic, viral hepatitis

94
Q

hemolysis labs

A 
inc reticulocyte count
inc serum LDH
dec haptoglobin
fragmented RBC on peripheral smear
anemia
95
Q

causes of anion gap metabolic acidosis

A
  • lactic acidosis
  • ketoacidosis
  • methanol/ formaldehyde
  • ethylene glycol ingestion
  • salicylate poisoning
  • uremia (ESRD)

-inc anion gap bc of inc non-chlorinated acids in serum

96
Q

HCV tx

A

peginterferon + ribavirin
+/- telaprevir or boceprevir (protease inhibitors)

contraindications: ongoing alcohol or drug abuse; major uncontrolled depression

97
Q

signs of laxative abuse

A

watery diarrhea
inc frequency and volume of stool
dark brown discoloration of colon with lymph follicles shining through on biopsy

Internal Medicine (9 decks)

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