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Internal Medicine > Uworld > Flashcards

Uworld Flashcards

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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
chronic HCV
-waxing & waning elevations of ALT & AST - mixed cryoglobulinemia - porphyria cutanea tarda - membranoproliferative glomerulonephritis
26
what is the mechanism of kidney damage in SLE patients?
- immune complex mediated | - low C3 from complement activation
27
drugs that cause idiosyncratic reactions?
isoniazid, chlorpromazine, halothane, antiretroviral therapy -NO rash, arthralgias, fever, leukocytosis, or eosinophilia
28
causes of ARDS?
- impaired gas exchange - dec lung compliance - pulmonary hypertension
29
side effects of isoniazid
peripheral neuropathy, hepatitis -give pyridoxine (vit B6) supplement for neuropathy tx
30
cause of isolated systolic HTN?
decreased elasticity of the arterial wall - inc risk of CVD event - tx: low dose thiazide, ACEI, or long-acting CCB
31
Factor V Leiden?
Factor V becomes resistant to inactivation by protein C --> hypercoaguable state --> DVT -commonly inherited disorder
32
PCP (pneumocystis PNA) prophylaxis?
TMP-SMX (trimethoprim-sulfamethoxazole)
33
tx for pericarditis
ibuprofen
34
what is the use-dependance phenomenon in anti arrhythmic medications?
- 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
35
acute-onset dyspnea + wheezing + prolonged expiration =
bronchoconstriction
36
psoriatic arthritis px?
-distal interphalangeal joints - morning stiffness - deformity - dactylitis ("saugsage digit") - nail involvement -tx: NSAIDs, methotrexate (RA is usually DIP joints)
37
what is ARDS?
acute respiratory distress syndrome - non-cardiogenic pulmonary edema - caused by leaky alveolar capillaries -mechanical ventilation: PEEP and low tidal volumes
38
what are the causes of ARDS?
sepsis, severe infection, severe bleeding, toxins, burns
39
aliskiren
= renin inhibitor
40
3 common causes of cough
- postnasal drip (upper airway cough syndrome) - asthma - GERD
41
ACEI-induced cough mechanism
increased [bradykinin] due to dec degradation of bradykinin-->substance P
42
late px of aortic coarctation
- asymptomatic HTN - epistaxis - upper extremity HTN, lower extremity hypotension - brachial-femoral delay - left ventricle hypertrophy (EKG) - intercostal artery notching (CXR)
43
side effects of thiazide diuretics
Hyper GLUC: - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia -hypoNa, hypoK
44
medications that cause hyperK
- nonselective beta blockers - ACEI - ARB - NSAIDs - K-sparing diuretics - cardiac glycosides (digoxin)
45
causes of hyperK
- medications - AKI or CKD - acidemia - hyperglycemia - tumor lysis syndrome -acute tx: calcium gluconate
46
EKG changes from hyperK
- peaked T waves - shorted QT interval - QRS widening
47
flail chest
- due to crush injury - >3 adjacent rib fractures that break in 2 places - respiratory distress - tachypnea with shallow breaths
48
pulsus paradoxus
fall in systolic pressure >10 mmHg during inspiration -causes: cardiac tamponade, asthma, COPD
49
signs of PE
``` SOB tachypnea hypoxemia tachycardia pleuritic CP hemoptysis low grade fever hemoptysis ```
50
Behecet's syndrome
multi-systemic inflammatory condition recurrent oral ulcers + genital ulcers + skin lesions (erythema nodosum) + uveitis - positive pathergy test - Asian, Turkish, Middle East populations
51
Reactive arthritis
urethritis + conjunctivitis + arthritis =Reiter's syndrome
52
endocardial fibroelastosis
occurs in first 2 years of life restrictive cardiomyopathy
53
hereditary hemochromatosis
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
neuroleptic malignant syndrome px?
``` 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
common causes of digital clubbing
- lung malignancy - cystic fibrosis - R-->L cardiac shunts -NOT from hypoxemia/COPD
56
"fight bite" tx
amoxicilling-clavulanate (Augmentin) =human bite --> polymicrobial coverage needed (gram+, gram-, and anaerobes)
57
SE of floroquinolone
tendinopathy or tendon rupture (Achilles most commonly) - rotator cugg, hand, biceps, thumb, etc - stop drug, avoid exercise
58
renal cell carcinoma
``` flank pain + hematuria + palpable abdominal mass LEFT scrotal varicocele paraneoplastic symptoms (anemia, erythrocytosis, thrombocytosis, fever, hyperCa, cachexia) ```
59
hyperCa induces?
urinary salt wasting -->volume depletion tx: saline hydration + bisphosphonates (long term tx)
60
congenital long QT syndrome
FH of sudden death prolonged QT interval syncope with triggers (exercise, swimming, sudden noise, during sleep)
61
torsades de pointes
= acquired long QT syndrome cause: hypoK, hypoMg
62
methotrexate
dihydrofolate reductase inhibitor DMARD = disease-modifying anti-rheumatic drug SE: macrocytic anemia, nauseas, stomatitis, rash, hepatotoxicity, interstitial lung disease, alopecia
63
common causes of avascular necrosis of bone (osteonecrosis)?
chronic corticosteroid use chronic excessive alcohol ingestion
64
hereditary spherocytosis
- 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
mild asymptomatic hyperCa + inappropriately high-to-normal PTH
familial hypocalciuric hypercalcemia - low urinary Ca - Ca/cr 0.02
66
pericarditis px
worsening CP with inspiration, improved leaning forward diffuse ST elevation reciprocal depression in avR tx: NSAIDs; corticosteroids in refractory cases
67
Dressler's syndrome
=pericarditis 1 week after an MI - immunologic phenomena - tx: NSAIDs - avoid anticoagulants to prevent hemorrhagic pericardial effusion
68
symptoms of alcohol withdrawal
reflex hyperactivity: - anxiety - insomnia - tremors - diaphoresis - hallucinations - withdrawal seizure - delirium tremens
69
what is delirium tremens
-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
opiod withdrawal px?
dilated pupils + piloerection + dysphoria + myalgias + abdominal pain -tx: methadone (long acting opiod --also for heroin addiction management)
71
lupus arthritis
- MCP & PIP joints | - non deforming (which is how it is differentiated from RA)
72
arthritis in DIP
OA (non-inflammatory) & psoriatic arthritis (dactylitis)
73
opiod intoxication
respiratory depression miosis sedation
74
lithium toxicity
tremor hyperreflexia ataxia seizures
75
phenytoin toxicity
horizontal nystagmus cerebellar ataxia confusion
76
CHADS2
``` 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
zinc deficiency
- alopecia - abnormal taste - bullous, pustulous lesions around perioral and periorbital areas -normally absorbed in jejunum
78
vitamin A deficiency
blindness dry skin impaired immunity
79
B12 deficiency
macrocytic anemia | neurologic symptoms
80
selium deficiency
cardiomyopathy
81
trastuzumab
- tx for HER2 breast cancer - HER2 gene detected by FISH or immunohistochemical staining =herceptin
82
DIC
thrombocytopenia + thrombosis + bleeding
83
hereditary telangiectasia
diffuse telangiectasias + recurrent epistaxis + widespread AV malformations - autosomal dominant - AVM in mucous membranes, skin, GI, liver, brain lung (--> chronic hypoxemia)
84
chronic bronchitis
chronic productive cough for 3 months in 2 successive years
85
anti-pseudomonal agents
cefepime meropenem piperacillin-tazobactam
86
hypoCa from transfused blood via..
- chelation by citrate anticoagulant - chelates Mg, as well - ->paresthesias -stored RBCs can also release K --> hyperK
87
type 4 RTA
- non-anion gap metabolic acidosis - aldosterone deficiency/ resistance - hyperK & acidosis -elderly pts with poorly controlled DB
88
loop diuretics cause metabolic______ & hyp___K
metabolic alkalosis | hypoK
89
venous thrombosis in what type of nephrotic syndrome?
membranous glomerulonephritis
90
3 types of DB retinopathy
- background/simple = microanneurysm, hemorrhage, exudates - pre-proliferative = cotton wool spots - proliferative/malignant = neovascularization
91
elevated AFP & beta-HCG + mediastinal mass
nonseminomatous germ cell tumor -seminomas only have elevated beta-HCG
92
choriocarcinoma
- elevated beta-HCG - associated with molar pregnancy - elevated beta-HCG also in seminoma
93
alcoholic hepatitis
AST:ALT >2 absolute values of AST & ALT always 25x upper limit = toxin-induced (acetaminophen), ischemic, viral hepatitis
94
hemolysis labs
``` inc reticulocyte count inc serum LDH dec haptoglobin fragmented RBC on peripheral smear anemia ```
95
causes of anion gap metabolic acidosis
- lactic acidosis - ketoacidosis - methanol/ formaldehyde - ethylene glycol ingestion - salicylate poisoning - uremia (ESRD) -inc anion gap bc of inc non-chlorinated acids in serum
96
HCV tx
peginterferon + ribavirin +/- telaprevir or boceprevir (protease inhibitors) contraindications: ongoing alcohol or drug abuse; major uncontrolled depression
97
signs of laxative abuse
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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