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Internal Medicine > UWorld > Flashcards

UWorld Flashcards

1
Q

Patients with prosthetic heart valves are most likely to get infective endocarditis with what organism?

A

Staph aureus

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2
Q

What are the ECG findings in mobitz type ii heart block?

A

PR interval remains constant with intermittent nonconducted P waves; QRS complex suddenly drops

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3
Q

What ECG findings are seen in Mobitz Type I heart block?

A

“Group beating;” progressive prolonged PR interval leads to nonconducted P wave; “Wenckeback”

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4
Q

What things worse and improve Mobitz type I heart block?

A

Exercise and atropine improve; vagal maneuvers worsen

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5
Q

What type of things improve and worsen Mobitz type II heart block?

A

Exercise and atropine worsen; vagal maneuvers paradoxically improve

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6
Q

What type of second degree heart block needs a pacemaker?

A

Mobitz type II

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7
Q

How is atrial fibrillation with rapid ventricular response, causing AMS, hypotension, acute heart failure, treated?

A

Synchronized cardioversion

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8
Q

What is the difference between cardioversion and defibrillation?

A

Cardioversion provides synchronized energy to the QRS complex - minimizes likelihood of shock occurring during repolarization; defibrillation provides high-energy shock at random point in the cardiac cycle

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9
Q

During what rhythm is defibrillation indicated?

A

Ventricular fibrillation or pulseless ventricular tachycardia

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10
Q

What is characteristically absent in an isoniazid drug-induced liver disease?

A

Extrahepatic manifestations such as rash, arthralgias, fever, leukocytosis, eosinophilia

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11
Q

What anti-tuberculosis drug causes hepatitis?

A

Isoniazid

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12
Q

What antibodies suggest a type 1 (classic) autoimmune hepatitis?

A

ANA and smooth muscle antibody

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13
Q

What drugs cause drug-induced liver disease of cholestasis morphology?

A

Chlorpromazine, nitrofurantoin, erythromycin, anabolic steroids

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14
Q

What drugs cause drug-induced liver disease of fatty liver morphology?

A

Tetracyclines, valproate, anti-retrovirals

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15
Q

What drugs cause drug-induced liver disease of hepatitis morphology?

A

Halothane, Isoniazid, alpha-methyldopa, phenytoin

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16
Q

What drugs cause drug-induced liver disease of toxic/fulminant morphology?

A

Carbon tetrachloride, acetaminophen

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17
Q

What medication is used to treat mild persistent asthma?

A

SABA + ICS

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18
Q

What is the presenting symptom in central retinal artery occlusion 2/2 embolism?

A

Painless loss of monocular vision

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19
Q

What is the treatment for central retinal artery occlusion?

A

Occular massage with O2 (hyperbaric can be helpful)

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20
Q

What is the urine osmolality in primary polydipsia after water deprivation test?

A

> 600; kidneys respond to ADH and resorb water

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21
Q

What is the the preferred initial therapy for central DI?

A

Desmopressin

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22
Q

What high risk comorbidities is it recommended to give PCV 13 followed by PPSV23 at an age <65?

A

Asplenia, CSF fluid leaks, cochlear implants, immunocompromised

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23
Q

What patients receive PPSV23 alone prior to 65?

A

Heart or lung disease, DM, smoking, chronic liver disease; at age 65 PCV13 followed by PPSV23 is given

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24
Q

What anticoagulants cannot be used in renal insufficiency?

A

LMWH (enoxaparin), fondaparinux (Xa inhibitor) and rivaroxaban

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25
Q

How is unfractionated heparin monitored?

A

aPTT

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26
Q

What is goal PTT for unfractionated heparin?

A

1.5 to 2x

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27
Q

Patients who receive solid organ transplant are put on what medication for prophylaxis against opportunistic infections?

A

TMP-SMX (patients with sulfa allergy should undergo desensitization if possible)

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28
Q

Massive PE is defined as what?

A

PE complicated by hypotension and/or acute right heart strain

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29
Q

What is the immediate treatment of hyperkalemia?

A

Calcium gluconate or calcium chloride infusion followed by insulin and glucose

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30
Q

What are the most common etiologies of chronic cough?

A

Upper airway cough syndrome (postnasal drip), GERD, and asthma

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31
Q

What is the initial therapy in aortic dissection? What is the goal of initial therapy?

A

IV beta blockers (and morphine for pain control); want reduction SBP (goal 100-120); decreased LV contractility

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32
Q

What is the first lab test in the work up of acromegaly?

A

IGF-I level

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33
Q

What arrhythmia is the most common cause of sudden cardiac death during acute myocardial infarction?

A

Ventricular fibrillation

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34
Q

What is the next best step when a patient has ventricular fibrillation?

A

Defibrillation

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35
Q

What diuretics can be used to treat hypercalciuria?

A

Thiazide diuretics; loops and K+ sparing make it worse

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36
Q

How is spontaneous bacterial peritonitis diagnosed?

A

Neurtorphils >250 in perotonitic fluid

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37
Q

How is serum to ascites albumin gradient calculated? And used?

A

Subtracting peritoneal fluid albumin concentration from serum albumin concentration; helps differentiate between portal and non-portal hypertensive etiologies

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38
Q

Patient has SAAG of 1.3. This indicates what as the cause of ascites?

A

Portal hypertension - cardiac ascites, cirrhosis

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39
Q

Patient has SAAG of .8. This indicates what as the cause of ascites?

A

Non-portal hypertension; eg malignancy, pancreatitis, Tb, nephrotic syndrome

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40
Q

What are the best markers indicating resolution of DKA?

A

Serum anion gap and direct assay of beta-hydroxybutyrate (predominant ketone in DKA)

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41
Q

Patients with Sjogren’s syndrome are more likely to develop what type of cancer?

A

Non-hodgkins lymphoma

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42
Q

What are the signs and symptoms of anticholinergic excess?

A

Dry mouth/dry skin (dry as a bone), blurry vision/mydriasis (blind as a bat), hyperthermia (hot as a hair), urinary retention (full as a flask), decreased bowel sounds, cutaneous vasodilation (red as a beet), and delirium/hallucinations (mad as a hatter)

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43
Q

Viral arthritis due to Parvovirus B19 typically affects one or multiple joints? And is symmetric or asymmetric?

A

Polyarticular and symmetric

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44
Q

Burning rubber or plastic puts people at risk for inhaling what poison?

A

Cyanide

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45
Q

How does infection with echinococcus granulosus present?

A

Patient visited rural, developing country; asymptomatic for years; liver cysts most common - RUQ pain, nausea, vomiting, hepatomegaly, fever and eosinophilia if rupture; lung cyst - cough, chest pain, hemoptysis

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46
Q

How is Echinococcus granulosus contracted?

A

Endemic to rural, developing countries; high in areas of sheep farming

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47
Q

How is Echinococcus granulosus treated?

A

Albendazole, percutaneous therapy (>5 cm or septations), surgery if rupture

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48
Q

Wide pulse pressure is seen in what type of coronary valve disease?

A

Aortic regurgitation; “water hammer” pulse

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49
Q

What are common causes of aortic root dilation?

A

Marfan syndrome, syphilis

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50
Q

What is seen on joint aspiration in calcium pyrophosphate crystal arthritis?

A

Inflammatory effusion (15,000-30,000 cells), rhomboid-shaped, weakly positive birefringent CPPD crystals

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51
Q

Which serologic test can be used to diagnose an early syphilis infection?

A

Treponemal (FTA-ABS, TP-EIA) vs Nontreponemal (RPR, VDRL)

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52
Q

What serologic test will be positive even after treatment for syphilis?

A

FTA-ABS and TP-EIA (Treponemal antibodies)

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53
Q

What type of nephrotic syndrome is clinically associated with African American and Hispanic ethnicity, obesity, HIV and heroin use?

A

FSGS

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54
Q

What type of nephrotic syndrome is clinically associated with adenocarcinoma (breast, lung), NSAIDs, hep B, SLE?

A

Membranous nephropathy

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55
Q

What type of nephrotic syndrome is clinically associated with Hep B, Hep C, lipodystrophy?

A

Membranoproliferative glomerulonephritis

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56
Q

What type of nephrotic syndrome is clinically associated with NSAIDs and lymphoma?

A

Minimal change disease

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57
Q

What type of nephrotic syndrome is clinically associated with upper respiratory tract infection?

A

IgA nephropathy

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58
Q

What can be used as primary prophylaxis in patients with esophageal varices to prevent variceal hemorrhage?

A

Nonspecific beta blocker (nadolol or propranolol) or endoscopic variceal ligation

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59
Q

At what age should screening colonoscopies start for classic familial adenomatous polyposis?

A

Age 10-12; repeat annually

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60
Q

At what age should screening colonoscopies start in patients with ulcerative colitis?

A

8-12 years after initial diagnosis; and every 1-2 years after that

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61
Q

Angiodysplasia is more frequently diagnosed in patients with what other diseases?

A

Aortic stenosis, vW factor deficiency, and renal disease

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62
Q

What is common clinical scenario of angiodysplasia?

A

Episodic, painless GI bleeding, usually >60 years old

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63
Q

How are patients with cocaine toxicity and myocardial ischemia treated?

A

Supplemental O2 and IV benzos

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64
Q

What are the major extra-renal complications of ADPKD?

A

Intracranial berry aneurysm, hepatic cysts, valvular heart disease, colonic diverticula, abdominal wall and inguinal hernia

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65
Q

What is the pathophysiology of tetanus toxin?

A

Toxin binds peripheral nerve terminals, and using retrograde axonal transport, arrives at the CNS synapse, where it blocks release of inhibitory neurotransmitters glycine and GABA

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66
Q

What are the characteristic features of pulmonary contusion?

A

Tachypnea, tachycardia, hypoxia with rales and decreased breath sounds, all which develop <24 hours after BTT

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67
Q

What can be seen on CXR in pulmonary contusion?

A

Initial CXR can be negative; can see patchy, alveolar infiltration not restricted by anatomical borders

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68
Q

What is the clinical presentation of left ventricular aneurysm?

A

Several months following MI, heart failure, angina, ventricular arrhythmia, systemic embolization

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69
Q

Why do patients sometimes have hyponatremia in the setting of HHS or DKA?

A

Pseudohyponatremia from hyperglycemia

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70
Q

Where is histoplasmosis found?

A

Midwest and central US (Ohio and Mississippi River Valleys) and in caves/soils contaminated by bird or bat droppings

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71
Q

What is the treatment of histoplasmosis?

A

Amphotericin B (moderate-severe disease), itraconazole (mild disease/maintenance)

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72
Q

What is seen on CT brain with contrast in patients with JC Virus?

A

Nonenhancing, hypodense with no surrounding edema (vs enhancing lesions seen in toxoplasmosis and B cell lymphoma)

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73
Q

What is the clinical presentation of reactive arthritis?

A

Occurs within 203 weeks of the onset of diarrhea and often characterized by concomitant urethritis, conjunctivitis/uveitis, malaise, and cutaneous findings

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74
Q

How does Whipple’s disease present?

A

Chronic malabsorptive diarrhea, weight loss, migratory non-deforming arthritis, lymphadenopathy, low grade fever

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75
Q

What is platypnea? When do you see it?

A

Platypnea is increased dyspnea while upright; seen in hepatopulmonary syndrome

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76
Q

What systemic disorders are associated with pyoderma gangrenosum?

A

Inflammatory bowel disease, rheumatoid arthritis, acute myeloid leukemia

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77
Q

How is pyoderma gangrenosum treated?

A

Local or systemic corticosteroids

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78
Q

What is a bacterial cause of ecthyma gangrenosum?

A

P aeruginosa

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79
Q

How does ecthyma gangrenosum typically present?

A

Hemorrhagic pustules with surrounding erythema that evolve into necrotic ulcers

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80
Q

What is the first serologic marker seen in acute hepatitis B?

A

HBsAg (appears 4-8 weeks after infection); IgM anti-HBc appears shortly after

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81
Q

What is used to treat/for Ppx for PCP in HIV if bactrim is not tolerable?

A

Pentamidine

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82
Q

What are the different etiologies of acute pericarditis?

A

Post myocardial infarction (early: peri-infarction pericarditis; late: Dressler syndrome), autoimmune (SLE), uremia, viral or idiopathic

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83
Q

What is seen on ECG in acute pericarditis?

A

Diffuse ST elevations and PR depressions

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84
Q

What is the treatment for viral and/or idiopathic acute pericarditis?

A

NSAIDs and colchicine

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85
Q

What is thromboangiitis obliterans?

A

Aka Buerger disease; occurs primarily in men who are heavy smokers; findings include superficial thrombophlebitis and ischemia and gangrene of the digits

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86
Q

What is Adult Still disease?

A

Inflammatory disorder characterized by recurrent high fevers, arthritis/arthralgias, and a salmon colored macular or maculopapular rash

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87
Q

What are the immunologic phenomena seen in infective endocarditis?

A

Positive RF, immune complex mediated glomerulonephritis, Osler Nodes

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88
Q

What are the two types of parapneumonic effusions?

A

Uncomplicated (sterile, resolves with Abx) and complicated (“need Abx and drainage)

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89
Q

What are the characteristics of a complicated parapneumonic effusion?

A

Pleural space invaded, patients continue to have fever and pleuritic CP despite Abx.

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90
Q

What does the pleural fluid show in complicated parapneumonic effusion?

A

PH <7.2, glucose <60, protein increased (due to permeability); gram stain neg; WBC >50,000

91
Q

What is the difference between empyema and complicated parapneumonia effusion?

A

Empyema has gross pus or bacteria on gram stain

92
Q

What are the characteristics of transudative effusions?

A

Low protein <3; glucose and pH are usually normal

93
Q

P < 0.01 is equivalent to what confidence interval?

A

CI of 99% (that does not contain the null value)

94
Q

If the null value is inside the confidence interval, what is the p value for a 95% and 99% CI?

A

> /= 0.05 for 95% CI and >/= 0.01 for 99% CI

95
Q

How does mixed cryoglobulinemia syndrome present?

A

Fatigue, nonblanching, palpable purpura, arthralgias, renal disase (hematuria, proteinuria, glomerulonephritis and peripheral neuropathies

96
Q

Mixed cryoglobulinemia syndrome is most commonly associated with what conditions?

A

Chronic inflammatory conditions such as HCV, SLE; patient with MCS should be tested for HCV/HBV/HIV

97
Q

What confirms mixed cryoglobulinemia syndrome serologically? Biopsy?

A

Cryoglobulins, low complement levels; skin/renal biopsy

98
Q

In what disease is ADAMTS13 activity decreased?

A

Thrombotic thrombocytopenic purpura

99
Q

How does TTP present?

A

Fever, MAHA, thrombocytopenia, purpura, kidney injury, neurologic findings

100
Q

What conditions are associated with type I cryoglobulinemia?

A

Lymphoproliferative and hematologic

101
Q

What is the treatment for nocardiosis?

A

TMP-SMX; carbapenems added for better coverage if brain is involved

102
Q

Tachypnea causes the pCO2to do what?

A

Becomes lower

103
Q

What is defective in type 2 renal tubular acidosis?

A

Defective tubular bicarbonate reabsorption in proximal tubules

104
Q

An estimated 10-year ASCVD risk of what is an indication for lipid-lowering therapy?

A

> 7.5%

105
Q

LDL above what number is an indication for lipid-lowering therapy?

A

LDL >190

106
Q

What arrhythmia is most specific for digitalis toxicity?

A

Atrial tachycardia with AV block

107
Q

Multifocal atrial tachycardia is commonly a consequence of what disease?

A

Pulmonary disease

108
Q

What is Ortner syndrome?

A

Voice hoarseness from recurrent laryngeal nerve compression due to LAE (seen in mitral stenosis)

109
Q

What is heard on cardiac exam in mitral stenosis?

A

Loud S1, loud P2 if pulm HTN, opening snap, mid-diastolic rumble

110
Q

What is seen on EKG in RVH?

A

Tall R waves in V1 and V2

111
Q

Expansile and eccentric lytic area in distal femur or proximal tibia in young adult with knee pain, swelling and decreased ROM is pathologic for what?

A

Giant cell tumor; “soap bubble” appearance

112
Q

What is the first line treatment for giant cell tumor of bone?

A

Surgery (intralesional curettage with or without bone grafting)

113
Q

What is seen on imaging in osteitis fibrosa cystica?

A

Subperiosteal bone resorption of radial aspect of middle phalanges, distal clavicular tappering, salt and pepper appearance of skull, brown tumors of long bones

114
Q

What is the clinical presentation of osteoid osteoma?

A

Pain worse at night, relieved by NSAIDs, sclerotic cortical lesion with nidus of lucency

115
Q

What are the clinical features of thyroid storm?

A

Fever, tachycardia, HTN, CHF, a fib, agitation, delirium, seizures, goiter, lid lag, tremor, n/v, diarrhea

116
Q

What are precipitating factors for thyroid storm?

A

Thyroid or non-thyroid surgery, trauma, child birth, acute illness/infection, acute iodine load (contrast)

117
Q

What is the treatment for thyroid storm?

A

Beta blocker, steroids, PTU followed by iodine solution

118
Q

Why is BUN and BUN:Cr ratio elevated in upper GI bleeds?

A

Increased urea production from intestinal breakdown of Hgb and increased urea reabsorption in proximal tubule due to hypovolemia

119
Q

What happens to PaCO2 in pulmonary embolus?

A

Decreases due to compensatory tachypnea (respiratory alkalosis); this is also seen in atelectasis, pleural effusion and pulmonary edema

120
Q

What is the treatment for vasospastic angina (Prinzmetal angina)?

A

CCB - diltiazem is best

121
Q

Why should ASA be avoided in patients with Prinzmetal angina?

A

Inhibits prostacyclin production which can worsen coronary vasospasm

122
Q

What is the treatment for Paget disease of the bone?

A

Bisphosphonates

123
Q

What are the levels of Ca and P in Paget disease of bone?

A

Normal

124
Q

Hypertensive hemorrhages resulting in lacunar strokes generally involve what regions of the brain?

A

Basal ganglia (putamen), lobar, thalamus, cerebellar nuclei

125
Q

What virus causes molluscum contagiosum?

A

Pox virus

126
Q

What are common causes of high anion gap with osmolol gap metabolic acidosis?

A

Acute ethanol, methanol or glycol poisoning

127
Q

What is seen in urinalysis of patients with ethylene glycol poisoning?

A

Enveloped shaped calcium oxalate crystals

128
Q

What are the etiologies of hypercoaguability in nephrotic syndromes?

A

Increased urinary loss of antithrombin 3, altered levels of protein C and S, increased Plt aggregation, hyperfibrinogenemia, impaired fibrinolysis

129
Q

Patients with nephropathy are likely to develop thrombosis where?

A

Renal vein

130
Q

What type of bullae are seen in pemphigus vulgaris?

A

Flaccid bullae (also ulcers)

131
Q

What are the clinical features of pemphigus vulgaris?

A

Flaccid bullae, ulcers, mucosal erosions, separation of epidermis by light friction (Nikolsky sign)

132
Q

What is seen in histopathology of pemphigus vulgaris?

A

Intraepidermal cleavage, acantholysis, tombstone cells along basal layer

133
Q

How is pemphigus vulgaris treated?

A

Systemic glucocorticoids, cortico-sparing agents, wound care

134
Q

Pemphigus vulgaris is autoimmune disorder with antibodies directed against what?

A

Desmogliens (1 & 3)

135
Q

What are the clinical features of bullous pemphigoid?

A

Pruritic, tense bullae in flexural surfaces, groin and axilla; mucosal involvement is uncommon

136
Q

What is the difference in treatment of exertional vs non-exertional heat stroke?

A

EHS treatment with ice-water immersion vs non-EHS cooling with evaporative cooling

137
Q

What are the clinical manifestations of paroxysmal nocturnal hemoglobinuria?

A

Fatigue due to hemolysis, cytopenias, venous thrombosis (intraabdominal and cerebral veins)

138
Q

What is seen on flow cytometry in PNH?

A

Absence of CD55 and CD59

139
Q

What is the treatment for paroxysmal nocturnal hemoglobinuria?

A

Iron and folate supplementation, Eculizumab

140
Q

What is cardiac index?

A

Measure of cardiac output (SV x HR) adjusted per body surface area

141
Q

What are the signs/symptoms of transfusion related acute lung injury?

A

Fever, hypotension and noncardiogenic pulmonary edema within 6 hours of blood product administration

142
Q

Joint aspiration with negatively birefringent needle shaped crystals is pathognomonic for what?

A

Urate crystals; gouty arthritis; the crystals are yeLLow when paraLLel to polarizing axis and blue when perpendicular

143
Q

Bite cells and Heinz bodies are pathognomonic for which disease?

A

G6PD def

144
Q

What is sialadenosis?

A

Noninflammatory swelling of salivary glands; associated with abnormal autonomic innervation of the glands

145
Q

MMR, zoster and varicella are contraindicated if CD4 count is less than what?

A

<200

146
Q

What are the indications for meningococcus vaccine?

A

Living in close quarters, asplenia, complement def

147
Q

What are the manifestations for babesiosis?

A

Fever, fatigue, myalgias, headache; if severe: ARDS, CHF, DIC, splenic rupture; anemia, thrombocytopenia

148
Q

How is babesiosis diagnosed?

A

Blood smear

149
Q

What is the treatment for babesiosis?

A

Atovaquone plus azithromycin; or quinine plus clindamycin for severe

150
Q

What is low T3 syndrome?

A

“Euthyroid sick syndrome;” fall in T2, normal TSH and T4; thought to be due to stress (elevated steroids, caloric deprivation, inflam cytokines)

151
Q

What is the treatment for cryptococcal meningoencephalitis?

A

Initial: amphotericin B with flucytosine; Maintenance: fluconazole

152
Q

What is the initial treatment for myasthenia gravis?

A

Acetylcholinesterase inhibitors (eg pyridostigmine)

153
Q

How is achalasia dagnosed?

A

Manometry (incr LES resting pressure) and barium esophagram

154
Q

What is the management of achalasia?

A

Upper endoscopy to exclude malignancy, laparoscopic myotomy or pneumatic balloon dilation, botulinum toxin injection, CCB and nitrates

155
Q

What antibody is diagnostic for RA?

A

Anti-CCP antibodies

156
Q

At what rate should hyponatremia be corrected?

A

Increase serum sodium 6-8 mEq/L in first 24 hrs

157
Q

What is seen on EKG in pericardial effusion?

A

Electrical alternans: varying amplitude of QRS complexes

158
Q

What are the two most common types of superior pulmonary sulcus tumors?

A

Squamous cell lung carcinoma and lung adenocarcinoma

159
Q

What is the CURB-65 criteria? What is it used for?

A

1 point for each: confusion, urea > 20, respirations >30/min, BP <90/60 and age >65; 0 = OP tx; 1-2 likely IP tx; 3-4 urgent IP tx

160
Q

Positive prussian blue stain of the urine indicates what?

A

Hemosiderin in the urine (due to hemolysis)

161
Q

What type of granulomas are seen in Crohn disease?

A

Noncaseating

162
Q

How is Giardiasis treated?

A

Metronidazole `

163
Q

What are the saline resistant metabolic alkaloses?

A

Primary hyperaldosteronism, Cushing’s syndrome, severe hypokalemia

164
Q

What is the gold standard confirmatory test for HIT?

A

Serotonin release assay

165
Q

How is hypernatremic hypovolemia treated?

A

IV NS first, once euvolemic treat with D5

166
Q

In differentiating folate vs cobalamin def., what is the next best lab test?

A

Methylmalonic acid - high in B12 def and normal in folate def.

167
Q

What are the secondary causes of calcium pyrophosphate dihydrate crystal deposition?

A

Hyperparathyroidism, hypothyroidism, hemochromatosis

168
Q

Diarrhea, ulcers in duodenum and jejunum, refractory to treatment is pathognomonic for what?

A

Zollinger-Ellison syndrome

169
Q

What is the treatment for bacillary angiomatosis?

A

Doxycycline or erythromycin; plus ART

170
Q

What are the aldosterone levels in primary and central adrenal insufficiency?

A

Aldosterone is low in primary AI, and normal in central AI

171
Q

What happens to calcium levels during a PE?

A

PE —> Resp alk —> H+ ions dissociate form albumin —> albumin and calcium bind —> decrease ionized calcium

172
Q

How is acute treatment of A fib with RVR in patients with wolff parkinson white treated?

A

Stable - give procainamide; hemodynamically unstable - electrical cardioversion

173
Q

What is postoperative endophthalmitis?

A

Infections of the eye (particularly the vitreous) within 6 weeks of surgery; patients present with pain and decreased visual acuity, swollen eyelid and conjunctiva, hypopyon, corneal edema and infection

174
Q

What is the treatment for postoperative endophthalmitis?

A

Intravitreal Abx injection or vitrectomy

175
Q

What are the symptoms of urge incontinence?

A

Sudden, overwhelming or frequent need to void

176
Q

What is the treatment for urge incontinence?

A

Lifestyle modifications, bladder training, antimuscarinic drugs (oxybutinin)

177
Q

What are the symptoms of stress incontinence?

A

Leakage with valsalva (coughing, sneezing, laughing)

178
Q

What are the treatment options for stress incontinence?

A

Lifestyle modifications, pelvic floor exercises, pessary and pelvic floor surgery

179
Q

What antibodies are associated with dermatomyositis?

A

Anti-Jo-1 (antisynthetase) and anti-Mi-2 (anti-helicase)

180
Q

How is beta blocker overdose treated?

A

Atropine first, followed by glucagon; also IV calcium vasopressors, high dose insulin and glucose, IV lipids

181
Q

What are the adverse effects of methotrexate?

A

Hepatotoxicity, stomatitis, cytopenias, alopecia, pulmonary toxicity

182
Q

What supplement should be given in addition to methotrexate?

A

Folate

183
Q

Urinary alkalization (pH > 8) in the setting of a UTI raises suspicion for what pathogen(s)?

A

P mirabilis (most common) and K pneumo; both urease producing

184
Q

How are mets detected in a carcinoid tumor?

A

Octreoscan

185
Q

Elevated 24 hour urinary excretion of 5-HIAA is suggestive of what?

A

Carcinoid syndrome

186
Q

What is the appearance of calcium pyrophosphate crystal arthritis?

A

Rhomboid shape, positive birefringence

187
Q

Cortisol has what kind of effects on skeletal muscle?

A

Catabolic, leading to atrophy

188
Q

What are the levels of ESR and CK in glucocorticoid induced myopathy?

A

Both normal

189
Q

What are the CK and ESR levels in polymyalgia rheumatica?

A

Elevated ESR, normal CK

190
Q

What is rare disease assumption?

A

Odds ratio (used in case-control studies) approximates relative risk (used in cohort studies) when the disease incidence is low

191
Q

Patient with dermal blisters on the hands and untreated hepatitis C is seen in what disease?

A

Porphyria cutanea tarda

192
Q

Renal vein thrombosis is most commonly seen in what nephrotic syndrome?

A

Membranous glomerulopathy

193
Q

What is the presentation of a renal vein thrombosis?

A

Patient with suspected nephrotic syndrome develops abdominal pin, fever, and hematuria; can also present slowly with gradual worsening of renal function and proteinuria

194
Q

What are common etiologies of avascular necrosis?

A

Steroid use, alcohol abuse, SLE, antiphospholipid syndrome, hemoglobinopathies, infections (osteo, HIV), renal transplant, decompression sickness

195
Q

When is azithromycin ppx started in HIV?

A

CD4 <50 ; ppx against MAC

196
Q

What is the MOA of octreotide in reducing portal blood flow?

A

Somatostatin analogue: causes splanchnic vasoconstriction and reduced portal blood flow by inhibiting release of glucagon

197
Q

Epitrochlear LAD is pathognomonic for what?

A

Secondary syphilis

198
Q

An alcoholic with hypocalcemia should be evaluated for what other electrolyte abnormality?

A

Magnesium - hypomagnesemia causes decreased release of PTH resulting in low calcium levels

199
Q

What is the pathophysiology of ARDS?

A

Lung injury resulting in cytokine/fluid leakage into alveoli, leading to impaired gas exchange, decreased lung compliance, and PHTN

200
Q

PaO2/FiO2 ratio of what is diagnostic of ARDS?

A

Less than or equal to 300 mmHg

201
Q

How is ARDS managed?

A

Mechanical ventilation: low TV, high PEEP, permissive hypercapnia

202
Q

Pleural effusions are exudative based on what criteria?

A

Light criteria: pleural fluid protein/serum protein ratio >0.5, pleural fluid LDH/serum LDH ratio >0.6, pleural LDH >2/3 upper limit of normal for serum LDH

203
Q

How is rhino-orbital cerebral mucormycosis treated?

A

Amphotericin B and surgical debridement

204
Q

What has been shown to improve morbidity and mortality in patients with known coronary artery disease?

A

DAPT (ASA + P2y12 inhibitor), spironolactone (aldo antagonist), beta blockers, ACEi, statins

205
Q

Tense bullae on an erythematous base is seen in what disease?

A

Bullous pemphigoid

206
Q

What is seen in immunofluorescense microscopy in bullous pemphigoid?

A

Linear IgG and C3 deposition along basement membrane

207
Q

How is bullous pemphigoid treated?

A

High potency topical glucocorticoids

208
Q

What is an abnormal Rinne test, and what is it suggestive of?

A

Bone conduction > air conduction; suggestive of conductive hearing loss

209
Q

What is a leukemoid reaction? And how is it different from CML?

A

Leukemoid reaction is a leukocytosis of >50,000 due to severe infections; LR has an elevated leukocyte alkaline phosphatase, CML has low LAP

210
Q

What is the clinical presentation of gonococcal infection?

A

Purulent monoarthritis and/or tenosynovitis, dermatitis (erythematous papules and pustules), asymmetric migratory polyarthralgias

211
Q

What is the treatment for disseminated gonococcal infection?

A

IV ceftriaxone (oral cefiximine when improved) and empiric azithromycin or doxy for concomitant chlamydial infection

212
Q

What pharmacologic agent is used in treating cancer related anorexia/cachexia syndrome?

A

Progesterone analogues

213
Q

How is an MS exacerbation/flare treated?

A

IV glucocorticoids, plasmapheresis if refractory to steroids

214
Q

What is the characteristic findings on chest CT in invasive aspergillosis?

A

“Halo sign” - nodules with surrounding ground glass opacities

215
Q

What is the clinical presentation of invasive aspergillosis?

A

Severely immunocompromised patient with fever, chest pain, and hemoptysis

216
Q

What is the treatment for invasive aspergillosis?

A

Voriconazole +/- caspofungin

217
Q

Patient with HIV presents with focal neurologic deficits and multiple ring enhancing lesions in gray-white matter junction and basal ganglia, what is the likely diagnosis?

A

Toxoplasma encephalitis

218
Q

What is the treatment of toxoplasma encephalitis?

A

Sulfadiazine & pyrimethamine (plus leucovorin)

219
Q

What is the initial treatment for febrile neutropenia?

A

Empiric monotherapy with anti-pseudomonal agent; eg cefepime, meropenem, pipercillin-tazobactam

220
Q

What are the lab findings in cholesterol crystal embolism?

A

Low complement, eosinophilia, and elevated serum Cr

221
Q

When is imaging appropriate in an uncomplicated pyelonephritis?

A

Persistent clinical sxs despite tx 48-72hrs, history of nephrolithiasis, or unusual urinary findings (gross hematuria, suspicion for urinary obstruction)

222
Q

What is complicated pyelonephritis?

A

Progression to renal corticomedullary abscess, perinephric abscess, emphysematous pyelonephritis, or papillary necrosis

223
Q

How are ureteral stones managed?

A

If less then 1 cm, managed medically (hydration, analgesics, and alpha blockers); alpha blockers (eg tamsulosin) help relax muscles

Internal Medicine (1 decks)

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