IM UW2 Flashcards by wallace M

What is the leading cause of blindness in industrialized countries?

Age-related macular degeneration (AMD)

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What causes Age-related macular degeneration (AMD)?

Chronic oxidative damage to retinal pigment epithelium & choriocapillaris

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Major risk factors for Age-related macular degeneration (AMD)?

Advanced age, smoking, family history

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Features of dry Age-related macular degeneration (AMD)?

Gradual bilateral vision loss, night-driving/reading difficulty, drusen deposits, pigment changes

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Features of wet Age-related macular degeneration (AMD)?

Acute vision loss, metamorphopsia (distorted lines), subretinal hemorrhage/fluid, gray-green discoloration

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Important lifestyle & preventive intervention in Age-related macular degeneration (AMD)?

Smoking cessation

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What supplements may slow progression in moderate–severe Age-related macular degeneration (AMD)?

Antioxidant vitamins + zinc

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Treatment for wet Age-related macular degeneration (AMD)?

Intravitreal VEGF inhibitors (ranibizumab, bevacizumab)

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Can peritoneal dialysis catheters be used immediately after placement?

Yes, but unsuitable in patients with poor manual dexterity or limited help

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What is the preferred access for chronic hemodialysis?

Arteriovenous fistula

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When should patients be referred for AV fistula creation?

~1 year before anticipated hemodialysis need (takes up to 6 months to mature)

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Why avoid waiting until urgent dialysis need?

Increased risk of arrhythmias, respiratory failure, complications

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Rhythm-control vs rate-control in AFib—what’s the risk?

Rhythm control has higher risk of adverse drug effects

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Should anticoagulation be continued in high-risk patients regardless of strategy?

Yes

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What causes Wernicke encephalopathy?

Thiamine deficiency

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Populations at risk for Wernicke encephalopathy?

Chronic alcohol use, malnutrition, anorexia nervosa, hyperemesis gravidarum, post-gastric bypass

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How to prevent iatrogenic Wernicke encephalopathy?

Give IV thiamine before or with dextrose

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What drugs are most associated with NMS?

Antipsychotics

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What else can trigger NMS?

Withdrawal/reduction/switch of dopamine agents in Parkinson’s patients

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What viruses can cause orchitis?

Mumps, rubella, parvovirus

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Common presentation of epididymitis?

Acute testicular pain, fever, urinary symptoms, tender swollen epididymis, intact cremasteric reflex

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Typical pathogens by age in epididymitis?

<35 yrs: Chlamydia trachomatis, Neisseria gonorrhoeae; >35 yrs or anal intercourse: E. coli

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Diagnostic test if exam equivocal?

UA, NAAT, urine culture
Doppler ultrasound (↑ flow to epididymis)

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Management of epididymitis?

Outpatient antibiotics, NSAIDs, testicular elevation, close follow-up

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What is age-related macular degeneration (AMD)?

drusen clustered around the macula.

What are drusen?

Yellowish deposits of lipids and calcium around the macula

Where are drusen typically located?

Around the macula.

herpetic whitlow

swollen and tender nail folds

Acute paronychia is a bacterial infection (most commonly Staphylococcus aureus) of the nail fold and surrounding tissues

nail plate pitting, nail bed salmon patches, and onycholysis

Psoriasis of the nail

Allergic contact dermatitis is a delayed hypersensitivity

Most common cause of wheezing?

Obstructive lung diseases (asthma, COPD)

What test is recommended in stable patients, with wheezing, to confirm diagnosis before therapy?

Spirometry

What test measures the amount of acid refluxed into the esophagus?

Impedance testing

What test can diagnose an esophageal diverticulum but carries perforation risk?

Esophagogastroduodenoscopy (EGD)

Current guidelines for surveillance in chronic hepatitis B or cirrhosis?

Ultrasound every 6 months

Best imaging modality to differentiate malignant vs regenerative nodules?

MRI of the liver

Management for liver lesions <1 cm in cirrhosis?

Repeat ultrasound in 3 months

Risk factors for septic arthritis?

Diabetes, HIV, rheumatoid arthritis, severe osteoarthritis, prosthetic joints

Typical presentation of septic arthritis?

Monoarthritis with restricted motion

Synovial fluid findings in septic arthritis?

Elevated WBC, Gram stain may be negative in 20–30%

Treatment for septic arthritis?

IV antibiotics + joint drainage

Three most important predictors of survival in advanced cancer?

Physician prediction, clinical symptoms, patient performance status

Symptoms associated with survival <30–38 days?

Dyspnea, dysphagia, confusion

Symptoms associated with survival <50–60 days?

Anorexia, xerostomia

Most important prognostic factor in advanced cancer?

Performance status (dependence in ADLs = worse prognosis)

2-3 weeks after streptococcal infection (eg, pharyngitis, cellulitis)

Guttate psoriasis

single or multiple round papules and plaques that are highly pruritic

Nummular eczema

erythematous, scaly plaques that develop atrophy and pigmentary changes over time

Discoid lupus

papulosquamous eruption

secondary syphilis

What autoantibodies are specific for primary membranous nephropathy?

Podocyte antigens (eg, PLA2R – phospholipase A2 receptor)

If podocyte autoantibodies are positive, how is primary MN diagnosed?

Diagnosis can be made without additional testing

Most common age-related vision disorder?

Presbyopia (impaired near vision due to lens stiffening)

What is a myopic shift, and what causes it?

Reduced distance vision, early effect of nuclear cataract due to lens thickening and dioptric power change

First-line treatment for antenatal depression?

SSRIs (especially sertraline – best studied for safety/efficacy)

Which SSRI is avoided in pregnancy and why?

Paroxetine (linked to small ↑ risk of congenital cardiac defects)

When is electroconvulsive therapy (ECT) indicated in pregnancy?

Severe depression with decompensation, suicidality, psychosis, refusal to eat/drink, or medication failure

Who should receive irradiated blood products?

Immunodeficient patients, family donor transfusions, HLA-matched platelet recipients

Are HIV patients at risk for transfusion-associated GVHD?

No – they can receive nonirradiated blood products

What is the effect of higher PEEP on oxygenation?

Improves oxygenation, no mortality difference

How does higher PEEP reduce lung injury?

Opens collapsed alveoli, distributes tidal volume, reduces atelectasis & ventilator-associated injury

Future risk for patients with gestational diabetes mellitus (GDM)?

Hi risk of GDM in subsequent pregnancies

When to Screen patient with prior history of gestational diabetes?

First-trimester glucose screening

Safest treatment for acute gout flare in patients with CKD?

Intra-articular corticosteroids

How can ventilator-induced lung injury be prevented in ARDS?

Low tidal volume (4–6 mL/kg ideal body weight), plateau pressure ≤30 cm H2O

What level of permissive hypercapnia is acceptable?

pH ≥7.20 (if no contraindications)

What imaging technique is more sensitive/specific for characterizing liver nodules

MRI is more sensitive/specific than CT or ultrasound.

Should AFP be relied upon for diagnosis of liver nodules?

Do not rely on AFP alone — it has poor sensitivity/specificity.

What is the management approach after diagnosis(liver cancer)?

Staging (Barcelona Clinic Liver Cancer – BCLC system) → consider resection, ablation, transplant, or systemic therapy depending on liver function and tumor burden.

What is the follow-up for liver nodules <1 cm?

US q3 months.

What is the follow-up for liver nodules 1–2 cm?

CT/MRI → if typical, HCC; if not, biopsy.

What is the follow-up imagine for liver nodules >2 cm?

CT/MRI → one study with classic features is diagnostic.

Allergic contact dermatitis is a delayed hypersensitivity

What is paradoxical vocal fold motion (PVFM)?

Abnormal adduction of the true vocal cords during inspiration.

How is PVFM often misdiagnosed?

As asthma (but lacks nocturnal symptoms and response to bronchodilators/steroids).

What are typical PVFM symptoms?

Dyspnea, throat tightness, inspiratory wheezing, dysphonia, cough.

What diagnostic test shows PVFM?

Spirometry with flow-volume loops (flattened inspiratory curve) or laryngoscopy (cord adduction).

Treatment for acute PVFM episodes?

Supportive (CPAP, heliox, sniffing/panting).

Long-term management of PVFM?

Speech therapy, psychological therapy, trigger avoidance.

When are diabetic foot ulcers likely to extend into bone?

>2 cm² and >2 weeks old.

Clinical signs suggesting osteomyelitis?

Erythema, warmth, swelling, tenderness, purulent drainage, exposed bone.

Best diagnostic test for osteomyelitis?

Bone biopsy with culture (unless blood cultures are positive).

Are wound cultures reliable in osteomyelitis?

No, they often reflect colonization.

Common cause of recurrent cellulitis after an initial episode?

Lymphatic stasis or skin barrier breakdown.

What skin condition predisposes to recurrent cellulitis?

Tinea pedis (entry point for bacteria).

Preventive step in cellulitis

Treat underlying tinea pedis.

Typical presentation of testicular cancer?

Painless scrotal swelling.

First diagnostic test for suspected testicular cancer?

Testicular ultrasound.

After ultrasound, what staging tests are required?

CT abdomen/pelvis (retroperitoneal nodes), chest x-ray, tumor markers (AFP, β-hCG).

Which tumor type has elevated AFP?

Non-seminomas.

How is testicular cancer definitively diagnosed?

Inguinal orchiectomy (biopsy is contraindicated).

What is the next step in a <60 y/o patient with dyspepsia and no alarm symptoms?

Non-invasive testing for H. pylori (urea breath test or stool antigen).

What must be stopped 2 weeks before testing for dyspepsia

Proton pump inhibitors (PPIs).

Where does a Pancoast tumor arise?

Apical pleuropulmonary groove.

Classic sign of Pancoast tumor

Shoulder pain, Horner syndrome, neurologic deficits (C8–T2 involvement).

MC initial symptom of Pancoast tumor

Shoulder pain.

First diagnostic test for suspected Pancoast tumor?

Chest x-ray.

What is Budd-Chiari syndrome?

Hepatic vein or suprahepatic IVC thrombosis.

MCC of Budd-Chiari syndrome

HCC, myeloproliferative disorders, OCP use, pregnancy, hypercoagulable states.

Acute presentation of Budd-Chiari syndrome

RUQ pain, hepatomegaly, jaundice, ascites, variceal bleeding.

Best initial diagnostic test of Budd-Chiari syndrome

Doppler ultrasound of hepatic veins.

Gold standard diagnostic test of Budd-Chiari syndrome

Venography

Management of Budd-Chiari syndrome

Diuretics, anticoagulation, angioplasty/stenting, TIPS/shunt, liver transplant if refractory.

IM UW2 Flashcards

(103 cards)