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IM Uworld > 6 > Flashcards

6 Flashcards

1
Q

^pulmonary artery pressure, ^right atrial pressure, normal PCWP, think ?

A

PE
^PA and RA pressures reflect right heart failure, normal PCWP reflects normal left heart function so etiology is pulmonary
MI (and tamponade) would result in ^PCWP as well as ^PA and RA pressures (LHF–>RHF)

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2
Q

if dx solid testicular mass + U/S suggestive of tumor, what to do next?

A 
radical orchiectomy (+ cord removal)
additional sx, radiation, chemo may be necessary
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3
Q

demeclocycline vs desmopressin

A

demeclocycline used in SIADH
desmopressin (ADH analog) for central DI
HCTZ for nephrogenic DI

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4
Q

PCV13 vs PCV23

A

PCV13 then PCV23 for adults 65+

PCV23 for adults younger than 65 who are smokers or have chronic conditions (DM, liver disease, HD, lung disease)

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5
Q

in Wilson’s, copper deposits in what organs?

how does it present?

A

liver, basal ganglia, cornia
kids/adolescents: liver disease
y. adults: neuropsych (tremor, rigidity, depression, paranoia, catatonia)

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6
Q

what coagulopathic changes seen in SLE?

A

prolonged PTT due to lupus anticoagulant (anti-phospholipid antibody)
+/- prolonged PT

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7
Q

why do patients with supravalvular aortic stenosis experience chest pain?

A

the outflow obstruction leads to LVH–>^myocardial O2 demand esp. during exercise–>subendocardial ischemia

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8
Q

1st line treatment for essential tremor

A

propranolol

alternates: primidone, topiramate

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9
Q

tick bite, febrile illness with systemic symptoms, leukopenia +/- thrombocytopenia and ^LFTs think ?
treatment?

A

Ehrlichiosis
(rash is uncommon unlike Lyme)
doxycycline

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10
Q

Alzheimer’s vs Dementia with Lewy bodies

A

AD: early findings: memory and visuospatial impairments, cognitive impairments, language difficulties
late: neuropsych, dyspraxia, lack of insight, non cognitive neuro deficits, incontinence
DLB: parkinsonism, fluctuating cognitive decline, visual hallucinations, extrapyr. symptoms THEN visuospatial and memory deficits

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11
Q

fever, cough, abdominal pain, diarrhea, night sweats, weight loss, splenomegaly, ^alk phos in an HIV+ pt with CD4 less than 50, think ?
how to tx?

A

MAC, disseminated
azithromycin or clarithromycin
(give ppx when CD4 less than 50)

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12
Q

drowsiness, confusion, dry mouth, dilated pupils, blurred vision, reduced bowel sounds, urinary retention, think what OD? how to tx?

A

diphenhydramine (Benadryl) 1st 2 symptoms: antihistaminergic, others: anticholinergic
tx with physostigmine: cholinesterase inhibitor

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13
Q

pronator drift tests for what dysfunction

A

UMN or pyramidal/corticospinal tract disease affecting the UEs

vs. Romberg’s which tests proprioception
vs. dysdiadochokinesia, ataxia, and intention tremor of cerebellar dysfunction

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14
Q

plantar warts are caused by what infection

A

HPV

most commonly in y. adults or immunocompromised individuals

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15
Q

molluscum contagiosum is caused by what infection

seen in whom?

A

poxvirus
single or multiple skin-colored papule with central umbilicus
prolonged course in immunocompromised i.e. HIV+ pts (consider testing if large, numerous, or widespread), also seen in children

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16
Q

ARDS dx: PaO2/FiO2 ratio and what does it imply

A

PaO2/FiO2 ratio less than 300; implies hypoxemia on supplemental O2 (i.e. ratio of 60 if PaO2 60 on 100% O2)
other dx criteria: resp distress 1 wk of insult, b/l lung opacities (edema) not due to CHF/overload

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17
Q

ARDS management

A

mechanical ventilation with low tidal volume, high PEEP, and permissive hypercapnia

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18
Q

vitamin A toxicity manifests as ?

A

dry skin, headache, blurry vision, may see abdominal pain and hypercalcemia

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19
Q

milk-alkali syndrome caused by ?

symptoms and findings?

A

excessive intake of Ca2+ and absorbable alkali
n/v/c, polyuria, polydipsia, neuropsych symptoms
^Ca2+, metabolic alkalosis, AKI, suppressed PTH

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20
Q

MRI of brain showing multiple, well-circumscribed lesion with vasogenic edema at the gray/white matter junction, think ?

A

metastasis to brain (lung most common)

vs. Primary CNS lymphoma: single periventricular lesion

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21
Q

proximal muscle weakness, dysphagia, and elevated CK, think ?
tx?

A

polymyositis

prednisone, MTX, azathioprine

22
Q

signs of right ventricular failure

A

^JVP, right ventricular 3rd heart sound, tricuspid regurg murmur, hepatomegaly w. pulsatile liver, LE edema, ascites +/- pleural effusions

23
Q

how to treat pregnant and lactating patients with Lyme disease

A

amoxicillin

doxy: teeth discoloration and retardation of skeletal development in fetuses/children

24
Q

abx not required for Lyme ppx if the tick has been attached for less than ?

A

36 hrs (1.5 days)

25
Q

abx not required for Lyme ppx if the tick has been attached for less than ?

A

36 hrs (1.5 days)

26
Q

if vitamin B12 is treated with folate and thiamine…

A

megaloblastosis and anemia will be corrected but leads to rapid progression of neurological symptoms (loss of proprioception, vibration, memory deficits, irritability, dementia)

27
Q

SEs of MTX

A

macrocytic anemia, nausea, stomatitis, rash, hepatotoxicity, intersitial lung disease, alopecia, fever

28
Q

SEs of MTX

A

macrocytic anemia, nausea, stomatitis, rash, hepatotoxicity, intersitial lung disease, alopecia, fever

29
Q

treatment of hemophilia

A 
factor VII (A) or IX (B)
desmopressin for mild hemophilia A
30
Q

female athlete triad

A

oligomenorrhea, osteoporosis, and decreased caloric intake

31
Q

sympathetic ophthalmia

A

“spared eye injury”
immune-mediated inflammation of one eye after penetrating injury to other eye; typically anterior uveitis
due to uncovering of “hidden antigens”

32
Q

higher titers of ? are associated with increased risk of miscarriage

A 
antithyroid peroxidase (anti-TPO) antibodies (associated with Hashimoto's)
in both euthyroid and hypothyroid women
33
Q

antibodies against TSH receptors cause what in the thyroid gland ?

A

atrophy (not enlargement)

less common cause of hypothyroidism (than anti-TPO)

34
Q

distortion of straight lines on visual exam, think ?

A 
macular degeneration (most common cause of blindness in industrialized nations)
can also see drusen deposits
35
Q

what skin lesion can be treated with dapsone

A

dermatitis herpetiformis

also gluten-free disease (celiac)

36
Q

TTP labs

treatment ?

A 
hemolytic anemia (^LDH, decreased haptoglobin) with schistocytes, thrombocytopenia (^bleeding time, normal PT/PTT), sometimes renal failure, neuro manifestations, fever (FATRN)
ADAMS13 deficiency
tx: plasma exchange
37
Q

parapneumonic effusions labs

A

pleural fluid with v. low pH (less than 7.2) and glucose (less than 60)

38
Q

how to calculate attributable risk

A 
ARP = (risk in exposed - risk in unexposed) / risk in exposed 
ARP = (RR - 1)/RR
39
Q

how to calculate attributable risk

A 
ARP = (risk in exposed - risk in unexposed) / risk in exposed 
ARP = (RR - 1)/RR
40
Q

study with 2+ variables that are studied independently

A

factorial design

41
Q

grouping of different data points into similar categories

A

cluster analysis

42
Q

acute respiratory failure, dry cough, fever in immunocompromised individual (i.e. on chronic steroids) + ^LDH think ?

A

PJP, course is more indolent in those with HIV

43
Q

ptosis, down and out, diplopia with normal pupillary response think ?

A

ischemic oculomotor palsy (affects inner somatic fibers, spares outer PS fiber)
poorly controlled DM

44
Q

“cape” distribution of pain/temp sensory loss + areflexic weakness in UEs think ?

A

syringomyelia: fluid filled cavity within the cervical and thoracic spinal cord
associated with Arnold Chiari malformation type 1
1st affects SpTT in anterior commissure (pain/temp)
dorsal column not affected (preserved prop/vibr)
anterior horn affected later: LMN signs, weakness

45
Q

why do you get “hypocalcemic” during alkalosis

A

less H+ bound to albumin, so more Ca2+ binds resulting in less unbound (ionized) calcium which is the physiologically active form, so can manifest as hypocalcemia

46
Q

numbness pain btw 3/4th toes with clicking sensation when squeezing the metatarsal joints

A

morton neuroma

47
Q

afib can result from ? due atrial strain from increased right atrial pressure

A

PE

48
Q

triad of disseminated gonococcal infection

A

polyarthralgias, tenosynovitis, vesiculopustular skin lesions

49
Q

oral and genital ulcers +/- skin and ocular involvement

A

Behcet syndrome
multisystem inflammatory condition
thrombosis most common cause of death

50
Q

what treatment for Graves can worsen ophthalmopathy

A 
radioactive iodine (RAI) due to raising titers of thyrotropin receptor antibodies (TRAB) on retro-orbital fibroblasts and adipocytes
tx: glucocorticoids and antithyroid drugs
51
Q

features of lacunar stroke

A 
pure motor hemiparesis
pure sensory stroke 
ataxic hemiparesis
dysarthria-clumsy hand syndrome 
\+ absence of cortical signs

IM Uworld (16 decks)

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