Uworld Int Med 7-27-2015

wumimimu's version from 2015-07-27 17:06


Question Answer
What are organophophates essentially?AchE inhibitors: can lead to cholinergic excess: bradycardia, miosis, ronchi, vomiting, diarrhea, urination, lacrimation,salivation
How do you treat organophosphate poisoning?Atropine and removal of clothes/washing of body to prevent further absorption
When does IBD present?Bimodal distribution..usually in 20's but then another peak around 60
How is the diagnosis of ankylosing spondylitis confirmed?AP xray showing fusion of SI joints and bamboo spine; if xray is equivocal, then MRI is indicated
What is cross sectional study?snap shot study where exposure and outcome are measured simultaneously
What is a complication of having Ankylosing spondy for more than 2 decades?Vertebral fractures due to osteopenia and osteoporosis that develops and also rigidity
Which cancer are those with hashimotos more predisposed to?Thyroid lymphoma
How can you diagnose thyroid lymphoma?Need core needle bx, and also thyroid US shows pseudocystic pattern; CT scan of the neck would show doughnut sign, compressive sx of enlarged thyroid
How does presbycusis present?Bilateral symmetrical high frequency hearing loss, presenting in the sixth decade of life; patients usually complain of difficulty hearing in crowded or noisy environments
How is vasovagal syncope diagnosed?usually this is clinical diagnosis- but if uncertain, can do tilt table test
What can incite vasovagal syncope?emotional or orthostatic stress, in those older than 60, might be micturation, defecation, or cough
How should you treat pencillin sensitive IE?IV aqueous pencillin G every 4-6 hours, or 24 hours cont infusion, Or once daily, ceftriaxone IV; both options for 4 weeks
What are the signs and sx of esophageal perf?Sudden onset, severe retrosternal, abdominal, or neck pain; air in the mediastinum, positve hammans sign (curnching sound during auscultation), subcu emphysema, widened mediastinum
How do you diagnose esphogeal perf?Gastrografin contrast (water soluble contrast) esophogram, or CT esophogram
How do you treat esophageal perf?Broad spectrum antibiotics, parenteral nutrition, and surgical repair
What are the symptoms of aminoglycoside induced vestibulopathy?oscillopsia, abormal head thrust test
How do you distinguish acute bacterial proatatits from cystitis?ABP has more severe systemic sx, regional pain, and tender prostate
What is the next step in management when acute bacterial prostatitis is suspected?Mid stream urine culture to guide antibiotic therpay
What antibitoics are used empirically when treating acute bact prostatits?TMP-SMX or fluoroquinolones
When should beta blockers be avoided after MI?If bradycardia or decompensated heart failure (flash edema)
What are complications of MI and what should be given?Persistent pain?- morphine, unstable sinus brady- atropine, flash pulm edema- furosemide
WHat are the usual therapies after acute mi?supp O2, aspirin 325, clopidogrel, high dose statin, beta blocker, nitro/morphine, anticoagulation
WHat is external validity?Generizability, can results apply to other groups too?
How is fibromyalgia diagnosed and assessed?Widespread pain index and symptom severity scale
What are the treatment for FM?First, good sleep hygeine, and aerobic exercise; then, TCA like amytriptyline, and SNRIs, and pregabalin
What is seen in generalized resistance to thyroid hormones?High THyroid hormones, and normal TSH: clinical sx of hypothyroidism
What is subclinical hypothyroidism?High TSH, normal T4 and T3 and no signs of hypothyroidism
When should pancreatic pseduocyst be drained?bigger than 5 cm, lasting greater than 6 weeks, infection
What CD4 count is cryptosporidium a concern in hiv patients?<180, persistent diarrhea ; acid fast oocysts in the stool
What other organism other than crypto can cause persistent diarrhea in hiv patients?microsporidia: however, spores in stools not acid fast oocysts
How long should atheletes with IM wait before playing sports?>/= 3 weeks and until all sx resolve
How should lyme disease in preg women and children <8 be treated?Oral amoxcillin
What is the most common site for ulnar nerve compression?The elbow, specifically, the medial epicondylar groove
What is first line therapy for meniere;s disease?Low salt diet, no caffeine, alc, or nicotine; if doesnt work, then antihistamines, diuretics, anticholinergics
Which drugs have shown to improve mortality in CHF?Sprinolactone, ace inhibitors, and beta blockers
When should you worry about lymph nodes?When they are firm and immobile, and >2.0 cm
What is the chemoprophy agent for TB?INH, for 9 months and should give with pyridoxine b6
What is aliskiren?Direct renin inhibitor
What are the initial treatments for PAD?Risk factor modification, supervised exercise program, cilostazol and surgcial/pC revasc if all else fails
in asymptomatic patient, how should hypercalcemia be addressed?obtain another calcium level to be sure, and then check pTH
WHen is parathyroidectomy recommended in asymptomatic pts with hypercalcemia?Ca levels >1 above normal, young <50, dexa scan c/w osteoporosis, and reduced renal function, GFR<60
What are open angle glaucoma sx?Gradual loss of peripheral vision, cupping of the optic disc, evntual tunnel vision, more common in AA with diabetes; treated with timolol eye drops, laser or surgical trabeculectomy
Which atypical pnm presents with erythema multiforme?Mycoplasma
What is contact lens ketatitis?painful red eye, opacification and ulceration of the cornea; medical emergecy, usual organisms are pseudomonas and other gram -, also fungi and amoebas,