Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UWorld > Incorrects 5 > Flashcards

Incorrects 5 Flashcards

1
Q

What test can differentiate achalasia and pseudoachalasia?

A

Endoscopic evaluation. Achalasia is due to nerve damage and pseudoachalasia is from cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

First test when Lupus suspected?

A

Anti-Nuclear Antibody (ANA). This test is highly sensitive for SLE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Second test when Lupus suspected?

A

Anti-DS DNA and/or Anti-Smith. These are very specific for SLE. A positive high sensitivity test must be followed up with a positive high specificity test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Antihistone antibodies are present in nearly 100% of what?

A

Drug induced lupus. Minocycline is less sensitive…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anti cyclic citrullinated peptide antibodies are used in Dx of?

A

Rheumatoid arthritis. This is a highly specific test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What vaccination can lead to intussusception in children?

A

Rotavirus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Testing appropriate in Hirschsprung disease?

A

Anorectal monometry (analyzes motility and pressure in distal bowel). Neonates with delayed meconium passage/bilious emesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Rx of leprosy with minimal lesions (paucibacillary)?

A

Dapsone and rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Rx of leprosy with extensive lesions (multibacillary)?

A

Dapsone, rifampin, and clofazimine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dx test in leprosy?

A

Biopsy from active lesion edge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Classic hand morphology in Diamond-Blackfan anemia?

A

Triphalangeal thumbs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Differences in anemia between Diamond-Blackfan and Fanconi anemia?

A

DB: Pure red cell aplasia
F: Pancytopenic bone marrow failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Milrinone is associated with increased mortality in?

A

Heart failure. It is a PDE 5 inhibitor and leads to increased contractility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What antibiotic can lead to hyperkalemia due to a similar mechanism as K+ sparing diuretics?

A

Trimethoprim.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drugs that commonly cause hyperkalemia?

A 
ß2 blockers
NSAIDs
ACEI, ARB, K+sparing diuretics
Digitalis
Cyclosporine
Heparin
Succinylcholine
Trimethoprim
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Venous stasis ulcers most commonly occur?

A

Pretibially or above the medial malleolus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diabetic foot ulcers most commonly occur with what?

A

Charcot foot deformity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Arterial ulcers most commonly occur where?

A

At the most distal part of the body (tips of toes/fingers).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathologically what does bland urine sediment represent?

A

An absence of intrinsic renal pathology (as would RBCs, casts, or protein).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Noninvasive positive pressure ventilation (aka CPAP) in acute COPD exacerbation is associated with a decrease in?

A 
Mortality
Intubation rate
Treatment failure
Length of hospital stay
Incidence of nosocomial infxn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cluster HA Rx?

A

Acute: Inhaled O2
Prophylactic: Verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Migraine HA Rx?

A

Acute: DHE or Sumatriptan (both 5HT1 receptor agonists)
Prophylaxis: TCAs or propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tension HA Rx?

A

NSAIDs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is amylase found in high concentration in pleural effusions?

A

Pancreatitis effusion or esophageal rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Postoperative fever occurring within 2 hours of surgery likely due to?

A
  • Prior infxn/trauma
  • Blood products
  • Malignant hyperthermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Postoperative fever occurring after 24 hours of surgery up to a week likely due to?

A
  • Nosocomial infxns
  • GAS or C. perfringens infxn
  • Noninfectious causes (PE, MI, DVT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Postoperative fever occurring after a week from surgery but under a month likely due to?

A
  • Catheter infxn (not GAS or C. dif)
  • C. difficile
  • Drug fever
  • PE/DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Postoperative fever occurring after a month from surgery likely due to?

A
  • Viral infxns

- Indolent infxns (eg TB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

MC transfusion reaction?

A

Febrile nonhemolytic. Occurs w/in 1-6 hours of transfusion. Cytokine accumulation in blood causes fever/chills. No hemolysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Acute hemolytic transfusion reaction labs?

A

Occurs w/in 1 hour of transfusion. Positive direct Coombs test due to ABO incompatibility. Fever, flank pain, hemoglobinuria, renal failure, DIC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Delayed hemolytic transfusion reaction labs?

A

W/in 2-10 days after transfusion. Positive direct Coombs w/ positive new antibody screen. Body develops new antibodies to recognized antigen (anamnestic antibody response). Mild fever and hemolysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Transfusion-related acute lung injury Sx?

A

W/in 6 hours of transfusion. Respiratory distress and noncardiogenic pulm edema occur due to donor anti-leukocyte antibodies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How is pulmonary edema during an MI managed?

A

IV Furosemide. Hypotension and hypovolemia are contras.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Percutaneous transluminal coronary angioplasty (PTCA) is preferred within how long after admittance to ER?

A

90 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is thrombolysis used in acute MI?

A

If PTCA is not available in 120 minutes, then do thrombolysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Highest risk antipsychotics for weight gain, dyslipidemia, and hyperglycemia (or even new onset DM)?

A

Clozapine and olanzapine. Monitoring requires BMI, fasting glucose/lipids, BP, and waist circumference.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lithium requires what testing?

A

Kidney and thyroid fxn. Nephrogenic DI, chronic interstitial nephritis, and hypothyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Gestational DM treatment 1st and 2nd line?

A

1: Dietary modification
2: Insulin, metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

2 hour postprandial blood glucose goals in pregnancy?

A

Fasting≤95
1hour postprandial≤140
2hour postprandial≤120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When to screen for gestational DM?

A

24-28weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Management of shoulder dystocia?

A 
BE CALM:
Breathe, no pushing
Elevate legs/flex hips (McRoberts)
Call for Help
Apply suprapubic pressure
enLarge vagina (episiotomy)
Maneuvers:
Woods screw (rotative pressure on anterior part of posterior shoulder)
Rubin (adductive pressure on posterior part of posterior shoulder)
Gaskin (all 4s)
Zavanelli (replace head - do csxn)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Main clinical features of NF1?

A 
Cafe au lait spots
Multiple neurofibromas (<6 may get optic pathay glioma)
Lisch nodules (in iris)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Main clinical features of NF2?

A

Bilateral acoustic neuromas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Retinitis Pigmentosa Sx?

A

Inherited degenerative disease of the retinal photoreceptor cells causing bilateral tunnel vision and eventually binocular blindness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is uveitis?

A

Inflamation of the uveal tract (iris, ciliary body, and choroid). Intense pain and photophobia in one eye is classic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Triad in hemolytic uremic syndrome?

A

Hemolytic anemia
Thrombocytopenia
AKI (elevated creatinine, hematuria, proteinuria, oliguria/anuria, HTN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Man acquires laceration on his friend’s ocean yacht. In 12 hours he has rigors and dark red bullae around the wound with red streaking up the leg. What Rx is suggested?

A

IV ceftriaxone and doxycycline. Highly virulent Vibrio vulnificus infxn can be fatal and develops in hours (vs staph/GAS which takes days). Individuals with liver disease are at increased risk (esp. hemochromatosis). Oyster ingestion are a common vector.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

MCC of fetal growth restriction?

A

Uteroplacental insufficiency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is required testing in fetal growth restriction?

A

Histopathologic examination of the placenta to look for infarction and/or infxn (eg spirochetes). Maternal substance abuse, genetic issues, or congenital infxn can cause fetal growth restriction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Define fetal growth restriction in a newborn.

A

Weight <10th percentile for gestational age. May have loose skin, thin cord, and wide anterior fontanel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

First line medication in angioedema leading to respiratory compromise in patient taking ACEI?

A

Epinephrine. If still refractory do emergency tracheostomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Unusual lab findings in Antiphospholipid syndrome?

A

Paradoxical aPTT prolongation not reveresed on plasma mixing studies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which type of drug reaction is dose dependent?

A

Type A. eg respiratory depression with opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which type of drug reaction is dose independent?

A

Type B. eg Stevens-Johnson syndrome with lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Addition of what medication to calcium channel blocker treatment of HTN can reduce peripheral edema SE?

A

ACEI or ARBs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Appropriate testing for Histoplasma capsulatum in HIV?

A

Urine or serum Histoplasma antigen testing is the test of choice for Dx (highly sensitive and rapid).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Both histoplasmosis and TB present with systemic symptoms (fever, chills, malaise), weight loss, cachexia, and pulmonary Sx. What PE Sx can differentiate them?

A

Mucocutaneous lesions (papules and nodules) are present in histoplasmosis and ARE NOT present in TB.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Proper management of mild or limited Histoplasmosis?

A

Itraconazole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Proper management of severe or systemic Histoplasmosis?

A

Amphoteracin B. Usually switched to oral itraconazole after 1-2 weeks and stay on it for a year or more for maintenance therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

When is caspofungin used?

A

Second-line in aspergillosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Flucytosine is used for?

A

Cryptococcus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Features of acute tubular necrosis?

A
  • BUN:Cr ratio <20:1
  • Urine osmolality of 300-350 (unable to concentrate urine)
  • Urine Na>20
  • FENa>2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Casts in acute tubular necrosis?

A

Muddy brown casts (renal epithelial cells). Sensitive, but nonspecific for ATN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Casts in chronic renal failure?

A

Broad casts or waxy casts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Casts in nephrotic syndrome?

A

Fatty casts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Casts in prerenal azotemia?

A

Hyaline casts. May be present in asymptomatic individuals also.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q 
Name the associated renal disease:
Muddy brown cast
RBC cast
WBC cast
Fatty cast
Broad and waxy casts
A 
MBC: ATN
RBC: Glomerulonephritis
WBC: Interstitial nephritis and pyelonephritis
Fatty: Nephrotic syndrome
Broad/waxy: Chronic renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Which Rx in Graves disease can worsen ophthalmopathy?

A

Radioiodine ablation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Methimazole and PTU SE?

A

Agranulocytosis. Methimazole is teratogenic in 1st trimester. PTU preferred.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Other PTU SE?

A

Hepatic failure, ANCA associated vasculitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Impaired myocardial relaxation and/or increased LV wall stiffness leads to?

A

An increase in LV EDP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Damage to the Edinger-Westphal nucleus would result in?

A

Ipsilateral fixed, dilated pupil without reactivity to light/accommodation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Damage to the lateral geniculate nucleus on the right would cause?

A

Contralateral homonymous hemianopsia. The lateral geniculate is located in the thalamus and relays visual info to the ipsilateral primary visual cortex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Damage to the medial lemniscus would cause?

A

Contralateral vibration, proprioception, and light touch loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

RFs for septic arthritis include?

A 
Abnormal joints (OA, RA, prosthesis, gout)
Age>80
DM
IV drugs/etoh
Glucocorticoid injxns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

MC organisms found in septic arthritis?

A

Gram-positive, unless IV drug use, immunosuppressed, or advanced age, then gram negatives.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Painless GI bleeding in a child with a positive 99mTc-pertechnetate scan identifies what Dx?

A

Meckel diverticulum. 99mTc-pertechnetate scan (Meckel’s scan) reveals denser uptake in an area of ectopic gastric mucosa and is helpful if gastric muscosa is present in a Meckel’s diverticulum which is 50% of cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

MCC of coagulopathy in a patient with malignancy?

A

DIC. Thus, thrombocytopenia, decreased fibrinogen, and increased INR in the presence of cancer Hx likely indicate DIC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Mild mitral stenosis is mostly heard in?

A

Late diastole (rumble at apex). But as it worsens, it gets closer and closer to the opening snap.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

An early diastolic murmur heard at the LLB is likely?

A

AR. Whereas MS is heard at the apex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

A late systolic murmur with a click that is heard over the apex radiating to the axilla is likely?

A

MVP.

82
Q

HOCM increases with murmurs that cause?

A

Increased outflow obstruction (eg Valsalva, standing from squatting [both reduce preload]). And is reduced by reduction of outflow obstrxn (eg handgrip [afterload up] and leg raise [preload up])

83
Q

Management of early pressure ulcers?

A

Elevation/relieving the pressure on the skin

84
Q

Management of frank pressure ulcers?

A

Elevation/relieve pressure and dress to maintain moist wound environment.

85
Q

Management of infected pressure ulcer?

A

Utilize topical antibacterail (silver sulfadiazine)

86
Q

A patient has thoracentesis to remove a pleural effusion. He presents within hours after with SOB and poor O2 sats with dullness to percussion in the chest wall. Dx?

A

Hemothorax. Rapid reaccumulation of pleural effusion with the other Sx would likely be due to bleeding into the pleural space.

87
Q

A diabetic patient presents with severe pain in the lower anterior abdomen with pain radiating into the scrotum. PE reveals edema and crepitus. Dx?

A

Fournier gangrene. This is a necrotizing fasciitis affecting the perineum or genitals. Severe pain in the abd. radiating to the genitals with edema, crepitus, and blisters/bullae require emergent surgical evaluation. More common in immunodeficient.

88
Q

Pain relief with elevation of a painful testicle indicates?

A

Epididymitis rather than torsion. Prehn sign. Low Dx quality.

89
Q

Cisplatin can cause what SE?

A

Nephrotoxicity, ototoxicity, neurotoxicity, and electrolyte abnormalities, as well as vomiting.

90
Q

Focal segmental glomerulosclerosis clinical associations?

A

African American or hispanic; obese; HIV/heroin use

91
Q

Membranoproliferative nephropathy clinical associations?

A

Hep B and C; lipodystrophy

92
Q

Minimal change disease clinical associations?

A

NSAIDs; lymphoma

93
Q

IgA nephropathy clinical assocations?

A

URI

94
Q

Membranous nephropathy clinical associations?

A

Adenocarcinomas; NSAIDs; Hep B; SLE

95
Q

Bronchial breath sounds over the periphery of the lung space indicates?

A

Consolidation or fluid filling alveoli. May occur in pulmonary contusions.

96
Q

Rx for pulmonary contusions?

A

Usually conservative: pain control, pulmonary hygiene, supplemental O2. Often resolve in a week.

97
Q

Juvenile myoclonic epilepsy progression?

A

Progression of worsening seizures. Beginning around 10 years of age absence seizures occur and later myoclonic seizures develop (around age 15). Generalized Sz then start to occur around 16years old.

98
Q

Pathophysiology behind virilization in Cushing syndrome?

A

Increase androgen prodxn in zona reticularis of adrenal cortex from ACTH stimulation. This is only present in ACTH dependent disease. ACTH indepenent does not present with this.

99
Q

Physiology behind nitrates relief of CP in MI?

A

Venodilation reduces preload, reducing ventricular volume and ventricular wall stress. MI O2 demand decreases. The relief is NOT primarily due to coronary artery dilation.

100
Q

Necrotizing enterocolitis presents with what classic sign on Xray?

A

Pneumoatosis or emphysematous intestinal tissue.

101
Q

What patient population is at risk of meningitis from Listeria?

A

Immunocompromised or age >50. Ampicillin is the Rx of choice.

102
Q

In suspected bacterial meningitis, what is empiric Rx?

A

Vanco and 3rd gen ceph (ceftriaxone)

103
Q

Most sensitive initial test in suspected malabsorptive syndrome?

A

Assay of stool for fat.

104
Q

MCC of aortic regurgitation?

A

Aortic root dilation or bicuspid valve (developed countries). RH is the MCC in developing countries.

105
Q

A decrescendo diastolic murmur after S2 in the Upper LSB?

A

Aortic regurgitation. Commonly radiates toward the right side when due to aortic root dilation.

106
Q

What needs to be considered with new onset aortic regurgitation and chest pain/back pain?

A

Ascending aortic aneurysm. This can lead to aortic root dilation and AR.

107
Q

An IV drug user presents with fever, focal back pain, and neurologic deficits that slowly develop over days after the back pain starts. Dx?

A

Spinal epidural abscess.

108
Q

Can the Centor criteria be used to Dx children?

A

No. They are unreliable in Dx for GAS pharyngitis in preadolescents. If suspected, do a strep test, if negative do culture. If positive, treat with PCN or ampicillin.

109
Q

Pt presents with anemia, leukopenia, thrombocytopenia and ovalomacrocytes and neutrophil hyposegmentation, hypogranulation on smear. Dx?

A

Myelodysplastic syndrome. Dx is with bone marrow biopsy. This is a hematopoietic stem cell neoplasm that causes dysplasia/cytopenias. Can transform to acute leukemia.

110
Q

Rx prior to surgery for pheochromocytoma?

A

Alpha and beta blockade. But first start with alpha (phenoxybenzamine), then beta blockade (propanolol) to avoid unopposed alpha.

111
Q

A 20s female presents with diarrhea, abd. pain, fever, and stinky vaginal secretions with weight loss. No blood in the stool. NAAT is negative. Dx?

A

Crohn’s disease. Can present with any of these Sx including rectovaginal fistula. Crohns affects mouth to anus and can cause fistulas to other hollow organs.

112
Q

MCC of postreptococcal glomerulonephritis?

A

Streptococcal skin infxn>strep pharyngitis

113
Q

A Pt starting chemotherapy presents with seizures and arrythmias. For days she complained of diarrhea and low urine output. Labs reveal hypocalcemia, hyperphosphatemia, and hyperkalemia with elevated uric acid levels. Dx?

A

Tumor lysis syndrome. Lysis of cells results in electrolyte release and sx.

114
Q

What anions are reduced that cause an anion gap metabolic acidosis?

A

Chloride or bicarbonate. Na - [Cl- + HCO3-] = anion gap

115
Q

Management of DKA and HHS?

A

0.9% saline initially with IV insulin. After glucose <200 or anion gap <12, give dextrose 5% and use SQ insulin. K+ should be given if ≤5.2. If serum K<3.3, hold insulin.

116
Q

Why is D-dimer of no value in pregnancy to rule out VTE?

A

Pregnancy affects D-dimer levels making them of no value.

117
Q

Which NNRTI can lead to CNS and psychiatric SE including bizzare, vivid dreams?

A

Efavirenz. Should be used cautiously in Pts with psych Hx. If severe Sx develop, stop and replace.

118
Q

First line nonmedical therapy for urinary urgency?

A

Bladder training. This includes delaying micturation to stretch the bladder.

119
Q

Pharmacologic Rx for urinary urgency?

A

Oxybutynin. This is an antimuscarinic. Others include Mirabegron, a ß3 agonist that relaxes the bladder in those who cannot take antimuscarinics.

120
Q

Gold standard test for Placenta previa?

A

Transvaginal US. Remember previa involves painless bleeding.

121
Q

Appropriate imaging for possible aortic rupture due to blunt chest trauma?

A

TEE (NOT TTE)
OR
Chest CT

122
Q

MC organism in an infected Bartholin gland abscess?

A

E. coli

123
Q

Rx for Bartholin gland abscess?

A

If ≥3cm, then I&D. Word catheter may reduce recurrence. Marsupialization reserved for recurrent abscesses after acute infxn resolves.

124
Q

Onycholysis can be a pathognomonic, yet rare, sign of what disease?

A

Graves disease. Other odd symptoms include clubbing of the fingers.

125
Q

Inability to extend the knee>135° when the hip is flexed is known as?

A

Kernig sign. This is suggestive of meningeal irritation.

126
Q

Passive flexion of the neck resulting in flexion of the lower extremities is known as?

A

Brudzinsks sign. This is a sign of meningeal irritation also.

127
Q

Abortive migraine therapies?

A

Triptans (sumatriptan)
NSAIDs/Tylenol
Antiemetics (promethazine, metoclopramide, prochlorperazine)
Ergots (dihydroergotamine)
***Mixing Triptans and ergots can lead to 5-HT overstimulation as they are both agonists. HTN/serotonin-like Sx occur.

128
Q

Preventive migraine therapies?

A

Topiramate
Divalproex
TCAs
ß-Blockers

129
Q

Rx administered in Kawasaki disease?

A

IVIG given w/in 10 days of fever onset will prevent coronary artery aneurysms. Aspirin (the only instance this is used in kids due to Reye’s syndrome) will help prevent coronary artery thrombosis.

130
Q

Superolateral displacement of the lens (ectopia lentis) is a potential complication of?

A

Marfan syndrome.

131
Q

Following splenectomy, what can occur in regards to platelet numbers?

A

Secondary thrombocytosis may occur. Normally, this thrombocytosis resolves in weeks, but some retain their numbers for months or years after surgery.

132
Q

Alcoholic liver disease can cause thrombocytopenia due to?

A

Decreased hepatic prodxn of thrombopoietin and/or direct marrow suppression from alcohol.

133
Q

A patient with persistent elevations in platelets (>600K) can paradoxically present with?

A

Hemorrhage. Though thrombosis can occur also.

134
Q

A sexually active female presents with dysuria due to urethritis and her UA reveals sterile pyuria (WBCs≥3/hpf present, but no bacteria). Dx?

A

Likely Chlamydia. If untreated can cause infertility/ectopic pregnancy.

135
Q

A female presents with amenorrhea for several months. She has associated weight gain and notices bilateral milky breast discharge. She denies HA or visual changes. Next step?

A

TSH first. Hypothyroidism and resultant TSH elevation can lead to weight gain and amenorrhea. It can also cause hyperprolactinemia. The lack of HA or visual changes also leans away from prolactin adenoma. Other considerations are prolactin (Brain MRI) and FSH testing (premature ovarian failure).

136
Q

First line tocolytic at 32-34 weeks gestation?

A

Nifedipine. Flushing, HA, and tachycardia/palpitations are SEs.

137
Q

First line tocolytic <32 weeks?

A

Indomethacin. Risk of oligohydramnios and PDA closure in fetus (that’s why contra’d at 32-34 wks).

138
Q

Short-term tocolytic for inpatient use?

A

Terbutaline. Can cause hypotension, tachycardia, and hyperglycemia as well as pulm. edema

139
Q

Alcohol consumption in the setting of severe hypertriglyceridemia (as in familial dysbetalipoproteinemia) can cause?

A

Pancreatitis. Fenofibrate is the best drug to reduce high TGs.

140
Q

Preterm labor Rx <32 weeks?

A

Betamethasone, tocolytics, mag, PCN (if GBS + or unknown)

141
Q

Preterm labor Rx b/t 32 and 34 weeks?

A

Betamethasone, tocolytics, PCN (if GBS + or unknown)

142
Q

Preterm labor Rx b/t 34 and 37 weeks?

A

Consider betamethasone, PCN (if GBS + or unknown)

143
Q

Initiate Rx for HTN in CKD with what BP?

A

≥140/>90. Goal is under this BP.

144
Q

Initiate Rx for HTN in otherwise healthy people with what BP?

A

≥150/>90. Goal is under this BP.

145
Q

Initial Rx choice in black person for HTN?

A

Thiazide or CCB (ACEI/ARB not first line UNLESS CKD present, then do ACEI/ARB)

146
Q

Initial Rx choice in any ethnicity but black for HTN?

A

Thiazide, ACEI/ARB, or CCB

147
Q

An US revealing an empty gestational sac without a fetal pole indicates?

A

Missed abortion. An empty sac without a fetal pole means there is no embryo. An embryo present without cardiac activity is also a missed abortion.

148
Q

Typical presentation of hydatidiform mole?

A

Heavy bleeding, snowstorm on US, with markedly increased ß-hCG (>100K)

149
Q

Hodgkin lymphoma Sx?

A

Painless lymphadenopathy and B symptoms in the setting of a normal peripheral smear and CBC.

150
Q

BP required for preeclampsia?

A

Over 140/90 at at least 20 weeks gestation. Proteinuria and/or end organ damage may be present.

151
Q

What are severe features of preeclampsia?

A

BP ≥160/110 (2x4hrs apart), signs of HELLP, pulmonary edema, or CNS sx

152
Q

Rx of preeclampsia?

A

Without severe features: ≥37 weeks deliver

With severe features:≥34 weeks

153
Q

Dx for preeclampsia?

A

Urine protein/creatinine ratio or 24 hour urine for protein collection

154
Q

Awake daytime hypercapnia is commonly due to?

A

Obesity hypoventilation syndrome. BMI ≥30.

155
Q

The presence of what feature on PE differentiates scarlet fever from mono?

A

Hepatosplenomegaly.

156
Q

Any palpable adnexal mass requires what test?

A

Pelvic US. Uterus, ovaries, and cul-de-sac are present on US. Tubes not present unless pathology exists.

157
Q

Why is polyhydramnios present in esophageal atresia with tracheoesophageal fustula?

A

The fetus cannot swallow amniotic fluid.

158
Q

Any newborn with tracheal and esophageal defects require workup for?

A

VACTERL (vertebral, anal atresia, cardiac, TEF, renal, and limb)

159
Q

Management of worsening respiratory status in myasthenia gravis (crisis)?

A

Intubate. Stop pyridostygmine (to reduce secretions and avoid aspiration). Do plasmapheresis and give steroids.

160
Q

Management of ß-thelassemia major? Minor?

A

Both genes mutated: Transfusions as severe anemia presents at early age.
One gene mutated: often mild Sx.

161
Q

Both lead and arsenic toxicity are very similar, but what differentiates them?

A

Arsenic poisoning may present with hypo/hyperpigmentation and hyperkeratosis of skin. GI sx and stocking glove neuropathy are typical for both. Chelation (dimercaprol and DMSA) is Rx for both.

162
Q

A study with a 95% confidence interval between 0.8 and 3.1 indicates what about that study?

A

The CI contains 1 and, thus, is NOT statistically significant. The p-value would be >0.05.

163
Q

Management of placenta previa in pregnancy?

A

Csxn delivery at 36-37 weeks when the lungs are developed.

164
Q

MCC of CAP is?

A

S. pneumoniae

165
Q

Basic idea in SCID?

A

Adenosine deaminase deficiency causes severe/recurrent viral, fungal, bacterial infxns and failure to thrive.

166
Q

Pts with complement deficiencies are at increased risk for?

A

Disseminated bacterial infxns (esp encapsulated)

167
Q

Impaired oxidative burst leads to?

A

Chronic granulomatous disease and recurrent skin and pulmonary infxns with catalase-positive organisms.

168
Q

Over 90% of primary adrenal insufficiency is due to?

A

Autoimmune adrenalitis.

169
Q

The vast majority of medulloblastomas occur where?

A

In the cerebellar vermis. Thus, truncal or gait ataxia would be expected. If occurring in the lateral cerebellum, dysmetria, intention tremor and dysdiadochokinesia would result.

170
Q

MC tumor in the cerebellum in children?

A

Astrocytoma. 2nd is medulloblastoma.

171
Q

A child with medulloblastoma presents with frequent headache and vomiting. What finding is expected on MRI?

A

Obstructive hydrocephalus.

172
Q

What tumor is associated with Parinaud syndrome?

A

Pineal tumors. Parinaud syndrome causes a limitation of upward gaze and downward gaze preference, bilateral eyelid retraction, and light-near dissociation.

173
Q

Best initial Rx for symptomatic HOCM?

A

Beta blockers. They prolong diastole and decrease myocardial contractility causing reduction in outflow obstrxn.

174
Q

MC early SE of carbidopa/levodopa?

A

Hallucinations, confusion, agitation. Dyskinesia can occur much later (5-10 years) in therapy.

175
Q

What is the most important prognostic consideration in breast cancer?

A

TNM staging is most important. Estrogen and progesterone positivity are good prognostic features. Her-2/neu oncogene overexpression worsens prognosis, but is not as significant as TNM.

176
Q

MCC of esophageal rupture?

A

Endoscopy. Dx requires water-soluble contrast esophogram to ID leak site. Surgery required to avoid mediastinitis.

177
Q

Dysgerminomas secrete?

A

LDH or ß-hCG. They are cells that differentiate into syncytiotrophoblasts of the placenta.

178
Q

What is the name of the teratoma (dermoid cyst) that produces thyroid hormone?

A

Struma ovarii.

179
Q

A patient with virilization and an ovarian mass may have?

A

Sertoli-Leydig cell tumor. They produce testosterone.

180
Q

Yolk sac tumors are the complement to what tumor in men?

A

Germ cell tumors (seminoma). They produce AFP.

181
Q

What must be considered in any case where diffuse maculopapular rash presents with a UA with WBC casts?

A

Acute interstitial nephritis. Drugs like NSAIDs, PCN, TMP/SMX, cephalosporins, and diuretics are the most common causes. Legionella and strep can cause it also.

182
Q

Sx in hypoplastic left heart syndrome?

A

Central cyanosis and heart failure in newborns. An underdeveloped left ventricle cannot support systemic circulation.

183
Q

Any patient with giant cell arteritis (ESR>50, HA, jaw claudication, fatigue, etc.) requires what imaging?

A

Serial CXR due to possible aortic aneurysm. Giant cell arteritis is known to involve branches of the aorta.

184
Q

In a normal distribution, where do the mean, median, and mode fall?

A

They are all equal at the top of the symmetrical bell curve.

185
Q

In a positively skewed distribution, where do the mean, median, and mode fall?

A

Mean>median>mode. Mode is at the peak. Median is the middle number. Mean is the average.

186
Q

In a negatively skewed distribution, where do mean, median, and mode fall?

A

Mode>median>mean. Again, mode is the peak. Median is the middle. Mean is the average.

187
Q

When is ERCP indicated?

A

When initial US or CT indicate obstrxn due to cholelithiasis or malignancy. ERCP can be both diagnostic and therapeutic.

188
Q

At what age are meningococcal vaccines administered?

A

11 and 16.

189
Q

How does management differ in bulimia vs anorexia nervosa?

A

SSRIs for bulimia, but CBT and nutrition for anorexia.

190
Q

Common SE of phenytoin?

A

Gingival hyperplasia, Stevens-Johnson syndrome and TEN.

191
Q

Foot drop, sensory changes over the dorsal foot and lateral shin and impaired dorsiflexion (no heel walking). Reflexes are normal and plantar flexion is present. Likely Dx?

A

Common fibular neuropathy. Leg immobilization, leg crossing, or squatting for extended periods can cause fibular head dysfxn leading to peroneal nerve entrapment.

192
Q

When is a urine anion gap calculated?

A

When there is a normal anion gap metabolic acidosis. The urine anion gap helps determine if the acidosis is from renal or intestinal bicarb losses. If the kidneys are responsible then RTA or carbonic anhydrase inhibitors are the cause. GI loss is usually diarrhea.

193
Q

Anterior shoulder dislocation results in holding the arm in what position?

A

Abduction and external rotation. Commonly due to fall with outstretched hand.

194
Q

Posterior shoulder dislocation results in holding the arm in what position?

A

Adduction and internal rotation. Commonly due to seizure or electrocution.

195
Q

Suspect what conditions (4) in a patient presenting with hypokalemia, alkalosis, and normotension?

A 
Surreptitious vomiting,
Diuretic abuse,
Bartter syndrome,
Gitelman's syndrome. 
***All present with previously stated Sx, but the last three present with high urine chloride content rather than low chloride.
196
Q

Pubertal boys with mild glandular tissue under the breast (considered gynecomastia) occurs as a result of?

A

Estrogen>testosterone prodxn during puberty by the testes. This usually resolves within months to years without intervention.

197
Q

Which congenital aberrancy results in increased male breast cancer risk?

A

Klinefelter Syndrome.

198
Q

How is lead usually absorbed in adults?

A

Respiratory tract. This is usually from soldering. Skin and GI tract absorb also.

199
Q

Aside from the 10 year ASCD risk ≥7.5%, what other indications for statin therapy exist?

A 
Known ASCVD (eg MI, storke, etc)
AND an LDL≥190, which usually indicates familial hypercholesterolemia.
200
Q

After 48 hours of symptomatic improvement, most hospitalized patients can be transitioned to?

A

Culture-guided oral antimicrobials rather than continue IV antibiotics.

UWorld (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions