Brainscape's Knowledge GenomeTM

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


See full index

Uworld Step 2 > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

Symptoms of Polymyalgia Rheumatica

A

> Age >50
bilateral pain and morning stiffness > 1 month
involvement of 2 of the following: neck or torso, shoulders or proximal arms, proximal thigh/hip, constitutional symptoms

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

Labs for polymyalgia rheumatica

A
  • ESR > 40
  • Elevated CRP
  • Normocytic anemia possible
  • ~20% can have normal labs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment for Polymyalgia rheumatica

A

low-dose glucocorticoids (NSAIDs for mild breakthrough pain while tapering steroids)

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

Clinical findings of HIV-associated nephropathy

A

> heavy proteinuria
rapidly progressive renal failure
renal biopsy showing collapsing focal segmental glomerulosclerosis
edema

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

What is being measured when performing an inspiratory hold on a pt on a vent?

A

Pulmonary compliance

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

What pathologies are associated with increased peak pressure and normal plateau pressure?

A

> bronchospasm
mucus plug
biting endotracheal tube
(These are causing increased airway resistance)

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

What pathologies associated with increased peak and plateau pressure?

A 
>pneumothorax
>pulmonary edema
>pneumonia
>atelectasis
>right mainstem intubation
(These reduce lung compliance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to measure auto-PEEP in a pt with obstructive lung disease?

A

end-expiration hold maneuver

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

Management of frostbite

A

> rapid rewarming in water bath
analgesia and wound care
angio or tech-99m scan to assess for thrombosis if rewarming unsuccessful
thrombolysis in severe, limb-threatening cases

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

Clinical symptoms of Chikungunya virus infection

A

> Pt visits Caribbean, central/south America, Africa, Asia
3-7 day incubation
high fever and severe polyarthralgia (almost always present)
headaches myalgia, conjunctivitis, maculopapular rash
Lymphopenia, thrombocytopenia, transaminitis

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

What screening should pts receive who are about to start Trastuzumab?

A

Baseline assessment of cardiac function by echocardiography

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

How does hepatorenal syndrome lead to renal dysfunction?

A

It causes splanchnic arterial dilation leading to renal vasoconstriction with decreased perfusion and GFR

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

Clinical findings of hepatorenal syndrome?

A

> significant decrease in GFR in the absence of another cause of renal dysfunction
minimal hematuria (<50)
lack of improvement with volume resuscitation

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

Treatment for hepatorenal syndrome

A

> address precipitating factors
splanchnic vasoconstrictors (midodrine, octreotide, NE)
liver transplant

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

Imaging test of choice for Hodgkin lymphoma

A

PET scan with 18-fluorodeoxyglucose (FDG)

will pool in healthy organs with high glucose needs like the brain, kidney, and liver. Cleared in urine so will pool in GU system so don’t get confused by that

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medications used for gastroparesis

A

> metoclopramide (extrapyramidal symptoms and tardive)
erythromycin (tachyphylaxis)
domperidone (cardiac arrythmias, QT prolongation, hyperprolactinemia)

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

First line therapy for renal artery stenosis (RAS)

A

ACE/ARBs are first line due to their ability to reduce angiotensin II levels, which improves systemic blood pressure and dilated the efferent arterioles (increases GFR)

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

Clinical findings of multifocal atrial tachycardia (3)

A

> typically, asymptomatic
rapid, irregular pulse
EKG: >3 P-wave forms, atrial rate >100/min, and irregular RR intervals

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

Treatment of multifocal atrial tachycardia

A

> correct the underlying disturbance

>AV nodal blockade (verapamil (CCB)) if persistent

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

What antibody is seen in PBC

A

anti-mitochondrial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What characterizes acute liver failure? (3)

A

> LFTs >1000
hepatic encephalopathy
synthetic liver dysfunction (prolonged PT and INR>1.5)

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

When is liver transplant required in pt with ALF?

A

> grade 3 or 4 hepatic encephalopathy
PT >100 seconds
serum creatinine >3.4

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

Clinical findings in pt with Meniere disease (3)

A

> recurrent episodes last 20 minutes to several hours
sensorineural hearing loss
tinnitus and/or feeling of fullness in ear

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

Clinical findings in pt with vestibular neuritis (3)

A

> acute, single episode that can last days
often follows viral syndrome
abnormal head thrust test

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

What is the cause of aplastic anemia?

A

bone marrow failure caused by damage to multipotent hematopoietic stem cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does vWF contribute to hemostasis? (2)

A

> aids in platelet-endothelial binding and platelet aggregation
carrier protein for factor VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Clinical features of paroxysmal nocturnal hemoglobinuria (3)

A

> hemolysis leadings to fatigue
cytopenia
venous thrombosis (intrabdominal, cerebral veins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment for paroxysmal nocturnal hemoglobinuria

A

> iron and folate supplements

>eculizumab (inhibits complement activation)

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

What test is used to confirm diagnosis of paroxysmal nocturnal hemoglobinuria?

A

flow cytometry to assess for the absence of the CD55 and CD59 proteins on the surface of the RBCs

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

Lab finds in pt with Beta cell tumor

A

> Increased insulin levels with low blood glucose
elevated C-peptide levels
proinsulin levels greater than 5pmol/L

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

What is the best index to monitor the response of treatment in a pt with DKA?

A

serum anion gap

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

Adverse effects of calcineurin inhibitors (tacrolimus, cyclosporine)

A

> vasoconstrictive properties
hepatically cleared so P450 altering drugs can lead to adverse effects
presents with HTN and prerenal acute kidney injury

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

How is subclavian steal syndrome diagnosed?

A

Doppler US or MR angio

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

What diseases are associated with erythema nodosum?

A 
>strep infection
>sarcoidosis
>TB
>endemic fungal disease (eg, histo)
>IBD
>Bechet disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a confounder?

A

extraneous factor that has properties linking it with both the exposure and the outcome of interest

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

What is the most common valvular abnormality detected in pts with IE?

A

mitral valve prolapse/regurgitation

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

Characteristic findings of pseudogout

A

> onset at age >65
monoarticular arthritis
chondrocalcinosis

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

Clinical signs of erysipelas

A

> acute onset of systemic symptoms
regional lymphadenitis
warm, tender, erythematous rash with raised, sharply demarcated borders

***involvement of the ear is suggestive of erysipelas since this skin lacks a lower dermis level

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

Most common organism involved in erysipelas

A

Group A strep

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

Treatment of erysipelas

A

> IV abx (ceftriaxone, cefazolin) if systemic symptoms

>Oral abx (amoxicillin) if no systemic symptoms

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

Clinical features of herpetic keratitis

A

> branched dendritic ulcerations
decreased corneal sensation
watery discharge
recurrent episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Clinical features of bacterial keratitis

A

> central, round ulcer
stromal abscess
mucopurulent discharge
acute presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Clinical features of fungal keratitis

A

> ulcerations with feathery margins and satellite lesions
mucopurulent discharge
indolent course

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

What is the most important factor for survival in a pt with sudden cardiac arrest?

A

Time to rhythm analysis and defibrillation if indicated

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

Hyperkalemic RTA is commonly seen in what pts?

A

elderly patients who have poorly controlled diabetes with damage to the juxtaglomerular apparatus, which causes a state of hyporeninemic hypoaldosteronism

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

Renal vein thrombosis is most commonly seen with what kidney disease?

A

membranous glomerulopathy (causes loss of antithrombin III)

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

Microcytic anemias. How does ferritin level relate to pathology?

A

> low = iron deficiency
normal = thalassemia
high = anemia of chronic disease or lead poisoning

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

Children and adults. What type of hemangioma do they get?

A

> adults get cherry (cherry in a drink)

> kids strawberry (strawberry patch kid)

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

Alarm features of IBS (9)

A 
>older age (>50)
>GI bleed
>nocturnal diarrhea
>worsening pain
>weight loss
>iron deficiency
>elevated CRP
> (+) fecal lactoferrin or calprotectin
>family history of early colon cancer or IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Clinical symptoms of transverse myelitis

A

> motor weakness that progresses from flaccid to spastic
autonomic dysfunction including bowel/bladder incontinence
sensory dysfunction including pain, paresthesia, or numbness with a distinct sensory level

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

How to distinguish hypertrophic cardiomyopathy from athlete’s heart

A 
>HCOM has weird EKG findings
>HCOM has enlarged left atrium
>HCOM LV wall will be >15mm
>HCOM focal septal hypertrophy 
>HCOM LV diastolic function impaired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Treatment for Guillain-Barre syndrome

A

> monitor of autonomic and respiratory function

>IVIG or plasmapheresis

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

What is the way they describe livedo reticularis in questions and what is it associated with?

A

painless, purple mottling of the skin (usually b/l LE or lower back)

cholesterol emboli

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

Pts taking isoniazid require supplementation with what?

A

pyridoxine (vit B6)

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

What will you see on echo and biopsy in a pt with viral myocarditis?

A

Echo: 4-chamber dilation with diffuse hypokinesis
Biopsy: lymphocytic infiltration, viral DNA or RNA

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

Electrical issues in what part of the heart lead to Atrial Flutter?

A

tricuspid annulus (don’t mix up with A fib which is from the pulmonary veins)

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

Treatment for uric acid stones

A

alkalinization of urine (potassium citrate)

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

Major risk factors for uric acid stones (4)

A

> gout
DM/metabolic syndrome
increased production of uric acid (hemolysis, MP disorders)
chronic diarrhea (due to loss of bicarb)

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

Pts with untreated hyperthyroidism can go on to develop what?

A

> Bone loss leading to osteoporosis and increased risk of fracture
also increased risk of cardiac tachyarrhythmias

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

Why do pts with sepsis develop hypoglycemia?

A

Increased use of glucose in the tissues, which is promoted by inflammatory cytokines

*Can also suppress gluconeogenesis

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

What can be observed in a pt with brain death?

A

DTRs because they originate in the spinal cord

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

Anterior uveitis can be associated with what diseases?

A

> certain infections
sarcoidosis
spondyloarthritis
IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How is anterior uveitis characterized?

A

painful, red eye associated with photophobia, tearing, and diminished visual acuity

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

Brown granular casts are associated with what renal issue?

A

Acute tubular necrosis

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

WBC casts are associated with what kidney issue?

A

Acute interstial nephritis

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

What is the classic triad of hereditary spherocytosis?

A

hemolytic anemia, jaundice, and splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is wrong in a pt with hereditary spherocytosis?

A

RBC scaffolding proteins (spectrin, ankyrin) are deficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What three things may a pt with hereditary spherocytosis require?

A

> cholecystectomy
folate supplementation
splenectomy (give vaccines as well if this happens)

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

What is the classic pentad of TTP?

A 
>thrombocytopenia
>MAHA
>renal insufficiency
>neurologic changes
>fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the best recommendation to prevent calcium stones?

A

Reduced sodium diet

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

Symptoms of Takayasu arteritis (3)

A

> constitutional
arterioocclusive in upper extremities
arthralgia/myalgias

**Distinguish this from coarctation with the systemic symptoms

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

What lab finding can be seen in a pt with obesity hypoventilation syndrome?

A

Decreased chloride due to bicarb retention

**Excreting chloride in the urine to reabsorb bicarb. Bicarb used to create metabolic alkalosis to compensate for respiratory acidosis

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

What imaging is used to diagnose fibromuscular dysplasia (FMD)?

A

CT angio of the abdomen

**If inconclusive then catheter based digital subtraction arteriography can be used

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

Adrenal vein sampling is used to distinguish between what two things?

A

> adrenal hyperplasia and adenoma

**Aldosterone/renin ratio will be >20

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

What is the cause of infertility in a pt with Klinefelter syndrome?

A

testicular fibrosis with seminiferous tubule dysgenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Clinical symptoms of idiopathic hypogonadotropic hypogonadism (Kallmann syndrome)

A

> anosmia (loss of smell)

>congenital abnormalities (cleft palate, skeletal abnormalities)

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

What is a common cause of constrictive pericarditis in developing or endemic area?

A

TB (Africa, India, China)

**USA MCC are idiopathic or viral (40%), radiation therapy (30%), cardiac surgery (20%), and connective tissue disorders

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

What medications are given to a pt with ACS due to unstable angina

A 
>antiplatelets
>anticoagulants
>beta blockers
>high-intensity statins
>nitrates as needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is one of the earliest findings in macular degeneration?

A

Distortion of straight lines such that they appear wavy (perform grid test to rule this out)

**Drusen deposits in the macula are also common lesions seen

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

Infectious mono typically appears with what findings? (5)

A 
>prolonged fever
>malaise
>exudative pharyngitis
>splenomegaly
>generalized lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Metoclopramide and prochlorperazine are what class of drug?

A

dopamine antagonists

**Can lead to EPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

MSK risk in pts with RA

A

osteopenia/osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the time frame onset in pts experience delayed hemolytic transfusion reaction?

A

> 24 hours and up to a month after transfusion

**B cell antibody response to minor antigens in transfused blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Warfarin affects what clotting and anticoagulant factors?

A

factors 2, 7, 9, 10

Protein C and S (these go first though)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Classic triad of dialysis-related amyloidosis

A

> scapulohumeral periarthritis
carpal tunnel syndrome
bone cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What will the calcium level be in pts with humoral hypercalcemia of malignancy (HHM)?

A

> 14mg/dL

*** Look for pt with smoking history, likely has squamous cell producing PTHrP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What will the calcium levels be in a pt with HCTZ induced hypercalcemia?

A

<12mg/dL

**use this to distinguish between this and hypercalcemia of malignancy (>14)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the most common side effect of hydroxyurea?

A

> myelosuppression

**neutropenia, anemia, thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Lab findings in a pt with adrenal insufficiency

A

> renal sodium wasting and potassium retention leading to hypotension/orthostasis
reduced cortisol production causing constitutional symptoms and hypoglycemia
eosinophilia due to reduced migration into tissues secondary to reduced cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What test should be performed to check for adrenal insufficiency?

A

cosyntropin stimulation test (synthetic form of ACTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What should be avoided in pts with premature atrial complexes?

A

> tobacco
alcohol
caffeine
stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What should be given in an agitated pt with delirium?

A

low-dose haloperidol

**can also use quetiapine, risperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Clinical features of Wernicke Encephalopathy (3)

A

> encephalopathy
oculomotor dysfunction (horizontal nystagmus and b/l abducens palsy)
postural and gait ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the timeframe of acute renal allograft rejection?

A

most commonly occurs within the first 6 months following transplant

**T cell mediated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What will biopsy show in acute renal allograft rejection?

A

lymphocytic infiltration of the intima with inflammatory tubular disruption

**T cell mediated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How will BK virus reactivation appear on renal biopsy?

A

intranuclear inclusion and a mixed lymphocytic and neutrophilic infiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Medical management for ascites (3)

A

> spironolactone with furosemide
alcohol abstinence, sodium restriction
avoid ACE/ARBs and NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Why does beta blocker overdose lead to hypoglycemia?

A

> beta blockers act as competitive antagonists to catecholamines –> prevents catecholamines from inducing hepatic glucose production and glycogen breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

First line treatment for beta blocker overdose

A

> IV fluids
atropine
glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Symptoms of crypto in pts with AIDS (CD4 <180)

A

> SEVERE WATERY DIARRHEA
low-grade fever
weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Symptoms of microsporidium/isosporidium in pts with AIDS (CD4 <100)

A

> watery diarrhea
crampy abdominal pain
weight loss
FEVER IS RARE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Symptoms of MAC in pts with AIDS (CD4<50)

A

> watery diarrhea
HIGH FEVER (>39 or 102.2)
weight loss

103
Q

Symptoms of CMV is pts with AIDS (CD4 <50)

A 
>FREQUENT, SMALL-VOLUME DIARRHEA
>HEMATOCHEZIA
>ABDOMINAL PAIN
>low grade fever
>weight loss
104
Q

Treatment ladder for BPH

A
  1. alpha-blockers

2. 5-alpha-reductase inhibitors

105
Q

What is a common side effect of calcium channel blockers?

A

peripheral edema (other major ones include HA, flushing, and dizziness)

**likely related to the preferential dilation of precapillary vessels which leads to increased capillary hydrostatic pressure

106
Q

What medications can be added to avoid peripheral edema in pts on CCBs?

A

ACE/ARBS

***cause post-capillary venodilation and help normalize the capillary hydrostatic pressure

107
Q

What is the most common complication of influenza?

A

secondary bacterial pneumonia

***MCO being strep pneumo or staph aureus

108
Q

Light’s Criteria

A
  • Protein ratio >0.5
  • LDH ratio >0.6
  • Pleural fluid LDH >2/3 ULN serum LDH

***if any are positive then it is exudative

109
Q

Actinic keratosis can progress to what cancer?

A

squamous cell carcinoma

110
Q

First line treatment for pts with fibromyalgia

A

> patient education
regular aerobic exercise
good sleep hygiene

111
Q

Second line treatment for fibromyalgia

A

TCAs or duloxetine

112
Q

Clinical findings of lumbosacral strain (3)

A

> pain in lumbar area, may radiate to butt, hips, thighs (above knee)
paraspinal tenderness
no neurologic deficits; negative straight leg raising test (if + then likely radiculopathy)

113
Q

Clinical features of glucagonoma (4)

A

> weight loss
necrolytic migratory erythema
DM/hyperglycemia
GI symptoms

114
Q

Most common cancer in pts with asbestosis exposure

A

bronchogenic carcinoma

115
Q

Clinical findings in hypertrophic osteoarthropathy

A

digital clubbing is accompanied by sudden onset arthropathy, commonly affecting the wrist and hand joints

116
Q

Most common organism in joint infections.
<3 months
3-12 months
>12 months

A

< 3 months: staph aureus, gram neg rods, anaerobes
3-12 months: coag neg staph, Propionibacterium species, enterococci
>12 months: staph aureus, gram neg rods, beta-hemolytic strep

117
Q

What are common causes of nephrotic syndrome in adults?

A

> membranous nephropathy
focal segmental glomerulosclerosis
amyloidosis

118
Q

What is the MCC of AA amyloidosis in the US?

A

rheumatoid arthritis

119
Q

Clinical manifestation of Human Monocytic Ehrlichiosis (3)

A

> flu-like illness (high fever)
neurologic symptoms (confusion)
rash is uncommon

120
Q

Treatment for Human Monocytic Ehrlichiosis

A

empiric doxycycline while awaiting confirmatory testing

121
Q

Imaging used in pancreatic cancer based on presence of jaundice

A

> If jaundice tumor is likely in head, use US

>If no jaundice, likely in body or tail, use CT

122
Q

Treatment for bacterial infectious keratitis

A

antibiotics that have pseudomonal coverage (moxifloxacin)

123
Q

What will special tests show in pts with alcoholic cerebellar degeneration?

A

> impaired tandem walking/heel-knee-shin

>preserved finger-nose testing

124
Q

Clinical manifestations of necrotizing otitis externa

A

> severe, unremitting ear pain (worse at night and with chewing)
deficits of lower cranial nerves (7,10,11)
granulation tissue in the external auditory canal
elevated ESR

125
Q

Treatment for necrotizing otitis externa

A

> IV antipseudomonal abxs (ciprofloxacin)

> possible surgical debridement

126
Q

Lab findings in ethylene glycol poisoning (3)

A

> high osmolar gap
increased anion gap metabolic acidosis
calcium oxalate crystals in urine

127
Q

Which antibodies are found in Sjogren syndrome?

A

anti-RO and anti-La

128
Q

RA can involve what part of the spine leading to what?

A

atlantoaxial joint which can lead to subluxation

129
Q

What is myoclonus status epilepticus?

A

The acute form of posthypoxic myoclonus that typically develops within 24 hours after the initial hypoxic insult while the pt is still unconscious

*Generalized myoclonus, if persistent is a marker of poor prognosis

130
Q

What is Lance-Adams syndrome?

A

the chronic form of posthypoxic myoclonus; presents days to weeks after the initial insult once the pt has regained consciousness

*Focal in nature

131
Q

What imaging should be performed in a pt with posthypoxic myoclonus?

A

EEG should be done to distinguish betwen other forms of seizure and PHM

132
Q

Which antibodies are found in a pt with SLE?

A

> antinuclear antibodies

>anti-dsDNA and anti-Smith

133
Q

What CNS manifestations are seen in SLE? (4)

A

> vasculitis
thrombotic or thromboembolic disease
seizures
transverse myelitis

134
Q

How do you diagnose hairy cell leukemia?

A

Bone marrow biopsy with flow cytometry

135
Q

Clinical findings and cause of Lemierre syndrome

A

> usually caused by gram-negative anaerobic bacillus Fusobacterium necrophorum
begins with an oropharyngeal infection
affects neuromuscular structures leading to internal jugular vein thrombosis

136
Q

When should Lemierre syndrome be considered?

A

In any toxic appearing pt with respiratory difficulties and significant neck swelling or tenderness in the week following an oropharyngeal infection

137
Q

What 3 things are required to diagnose acute renal failure?

A

> severe acute liver injury (LFTs >1000)
signs of hepatic encephalopathy (confusion, asterixis)
synthetic liver dysfunction (INR >1.5)

138
Q

First line treatment in a stable pt with A fib

A

> rate control (beta blocker or non-hydropyridine CCB)

139
Q

Clinical findings in leprosy

A

> macular, anesthetic skin lesions with raised borders

>nodular, painful nearby nerves with loss of sensory/motor function

140
Q

How do you diagnose leprosy?

A

> full thickness biopsy of skin lesion along the active edge

>M leprae cannot be cultured

141
Q

Treatment for leprosy

A

> dapsone + rifampin

>add clofazimine if severe

142
Q

What are precautions/contraindications to metformin?

A

> renal insufficiency (check serum creatinine)
hepatic insufficiency
decompensated heart failure

143
Q

How to diagnose Babesiosis

A

> thin blood smear: intraerythrocytic rings (“Maltese cross”)

144
Q

Treatment for Babesiosis

A

> atovaquone + azithromycin

>quinine + clindamycin (if severe)

145
Q

> internuclear ophthalmoplegia involves damage to what part of the brain?

A

damage to the heavily myelinated fibers of the medial longitudinal fasciculus (MLF)

**mediates communication betweeen CN III and VI nuclei

**unilateral = lacunar stroke
bilateral = MS
146
Q

A lesion in the medial lemniscus would result in what?

A

contralateral loss of vibration, proprioception, and light touch

147
Q

What are high risk features of a pancreatic cyst? (4)

A

> large size (>3 cm)
solid components or calcifications
main pancreatic duct involvement (ductal dilation)
thickened or irregular cyst wall

148
Q

Treatment for post-cardiac injury syndrome

A

> NSAID (usually high-dose aspirin) +/- colchicine

>corticosteroids in refractory disease

149
Q

Clinical presentation of drug-induced acne (3)

A

> monomorphic papules or pustules
lack of comedones, cysts, and nodules
location and age of onset may be atypical for acne

150
Q

Common triggers of drug induced acne (4)

A

> glucocorticoids, androgens
immunomodulators
anticonvulsants, antipsychotics
anti TB drugs

151
Q

What two lab values provide the best analysis for a pt’s acid-base status?

A

pH and PaCO2

152
Q

Treatment for acute aortic dissection (4)

A

> pain control (morphine)
IV beta blockers
+/- sodium nitroprusside (if SBP > 120mmHg and beta blockers didn’t work)
emergent surgical repair for ascending dissection

153
Q

What drug to give for V tach and SVT

A

V tack: IV amiodarone
SVT: adenosine
Unstable: both received synchronized cardioversion

154
Q

Primary polydipsia is more common in what pts?

A

psychiatric pts possibly due to a central defect in thirst regulation

155
Q

Management of triglyceride-induced pancreatitis

A

> triglycerides >500 consider insulin infusion

>triglycerides >1000 or severe pancreatitis consider apheresis (therapeutic plasma exchange)

156
Q

What antibodies are seen in diffuse cutaneous scleroderma?

A

> anti-Scl-70 (topoisomerase-1)

>anti-RNA polymerase III

157
Q

What antibodies are seen in limited cutaneous scleroderma (CREAST syndrome)?

A

> anti-centromere

158
Q

What causes the “pounding” sensation in pts with Carcinoid?

A

due to flushing and associated rise in pulse rate

159
Q

First line treatment for chronic venous insufficiency

A

> leg elevation
exercise
compression stockings

**If pt does not response then duplex US should be done to identify venous reflux

160
Q

What will be seen on peripheral blood smear in a pt with scleroderma renal crisis?

A

> schistocytes

**presents like MAHA or DIC along with thrombocytopenia

161
Q

When would Burr cells be seen on blood smear?

A

liver disease or end stage renal disease

162
Q

When would target cells be seen on blood smear?

A

Pts with hemoglobinopathies (eg thalassemia) or chronic liver disease (especially obstructive liver disease)

163
Q

If a pt has a stepwise decline in function and mental status what should be suspected?

A

vascular dementia

**cortical infarcts affect behavior
subcortical infarcts affect motor and sensory

164
Q

What heart sound is associated with acute coronary syndrome (ACS)?

A

S4

**decrease in ATP does not allow the muscle to relax producing a stiffened left ventricular wall which causes the murmur

165
Q

Clinical findings for a pt with multiple myeloma? (7)

A 
>constitutional symptoms
>bone pain
>hypercalcemia
>renal insufficiency
>normocytic anemia
>protein gap (>4)
>rouleaux formation on blood smear
166
Q

Management of pt with symptoms and calcium >14?

A

> normal saline hydration plus calcitonin
avoid loop diuretics unless volume overload

*do this as pt typically volume-deplete due to polyuria and decreased oral intake

167
Q

Treatment for prolactinoma

A

> dopaminergic agonists (cabergoline, bromocriptine)

>if these do not work or pt cannot tolerate then surgical resection

168
Q

When should treatment be started for a prolactinoma?

A

> macro prolactinoma (>10mm)
risk or presence of neurologic symptoms
hypogonadism
galactorrhea

169
Q

Clinical features of normal pressure hydrocephalus (5)

A

> gait instability (wide based) with frequent falls
cognitive dysfunction
urinary urgency/incontinence
depressed affect
upper motor neuron signs in lower extremities

170
Q

What life threatening coagulopathy is seen in pts with APML?

A

DIC

171
Q

What antibodies are seen in Antiphospholipid syndrome?

A

Anti-cardiolipin

172
Q

What antibodies are seen in pts with autoimmune hepatitis?

A

anti-smooth muscle

173
Q

If person was vaccinated for Hep B what will serology show?

A

Hep B surface antibody (HBsAb)

**HBcAb will be present if the person contracted the virus and then cleared it

174
Q

Which drugs can lead to SIADH?

A

> carbamazepine
SSRIs
NSAIDs

175
Q

Antibodies in bullous pemphigoid attack what part of the skin?

A

hemidesmosomes

176
Q

Treatment for bullous pemphigoid

A

topical: high potency steroids
systemic: steroids, doxycycline

177
Q

What should you do with vent settings if PaO2 >90 or <60

A

> 90: decrease FiO2

<60: increase PEEP

178
Q

What should you do with vent setting if

> increased PaCO2 and pH <7.25
decreased PaCO2 and pH > 7.45

A

> increase RR or ventilation

>decrease RR and ventilation

179
Q

When is anemia with reticulocytosis seen?

A

> acute bleeding

>hemolysis

180
Q

CLL is associated with what type of anemia?

A

warm autoimmune hemolytic anemia

**IgG attacks RBCs

181
Q

Phenytoin should be supplemented with what?

A

folic acid

182
Q

Treatment for QRS prolongation

A

sodium bicarb

183
Q

How can leukocyte alkaline phosphatase (LAP) be used to distinguish between leukemoid reaction and CML

A 
leukemoid = High
CML = Low
184
Q

Initial diagnostic evaluation in first-time seizure pat in adults is aimed at excluding what?

A

metabolic and toxic causes

**perform EKG as well to rule out arrhythmias

185
Q

Management of chest pain in pt with cocaine intoxication

A

> benzo for blood pressure and anxiety
aspirin
nitroglycerin
immediate cath if indicated

186
Q

If pt has chronic kidney disease, excessive bruising, and normal coagulation studies what should you be thinking?

A

platelet dysfunction

*** pts with CKD have high nitric oxide levels which decreases platelet adhesion, activation, and aggregation

187
Q

Clinical presentation of tinea corporis (ringworm)

A

> scaly, erythematous, pruritic patch with centrifugal spread

>subsequent central clearing with raised annular border

188
Q

Associated neoplasms in Lynch syndrome (3)

A

> colorectal cancer
endometrial cancer
ovarian cancer

189
Q

Associated neoplasms in FAP (3)

A

> colorectal cancer
desmoids and osteomas
brain tumors

190
Q

Associated neoplasms in von Hippel-Lindau syndrome (3)

A

> hemangioblastomas
clear cell renal carcinoma
pheochromocytoma

191
Q

MEN1 neoplasms (3)

A

> parathyroid
pancreatic
pituitary

192
Q

MEN2A neoplasms (3)

A

> parathyroid
medullary thyroid
pheochromocytoma

193
Q

Clinical features of idiopathic intracranial hypertension (4)

A

> HA/N/V
visual changes (diplopia due to abducens nerve palsy)
pulsatile tinnitus
retrobulbar pain/neck pain/back pain

194
Q

Diagnosis of idiopathic intracranial hypertension (4)

A

> papilledema and enlarged blind spots
MRI to rule mass/hydrocephalus
MR venography to rule out venous thrombosis
lumbar puncture: shows elevated opening pressure

195
Q

Long term medical management for idiopathic intracranial hypertension

A

acetazolamide

** may consider repeat LP of CSH shunt if vision becomes threatened

196
Q

Treatment for uncomplicated acute pyelonephritis

A

> oral fluoroquinolone, trimethoprim-sulfamethoxazole

>IV if vomiting, elderly, septic

197
Q

Treatment for complicated acute pyelonephritis

A

> IV fluoroquinolone, aminoglycoside, extended spectrum beta-lactam/cephalosporin

198
Q

What is considered salvage therapy?

A

Defined as a form of treatment for a disease when a standard treatment fails

199
Q

What is consolidation therapy?

A

therapy typically given after induction therapy with multidrug regimens to further reduce tumor burden

** an example is multidrug therapy after induction therapy for acute leukemia

200
Q

Hodgkin lymphoma is associated with what virus in immunosuppressed pts?

A

EBV

201
Q

Methylmalonic acid levels to distinguish folate vs B12 deficiency

A 
high = B12 deficiency
normal = folate deficiency
202
Q

How is CLL diagnosed?

A

flow cytometry showing a clonality of mature B cells

203
Q

What will be seen on peripheral blood smear in a pt with CLL?

A

smudge cells (CLL = crushed little lymphocyte)

204
Q

What should you do before starting amiodarone?

A

check to see if they are taking digoxin

** if they are then decrease dose by 25-50%

205
Q

What is a characteristic feature of euthyroid sick syndrome?

A

decreased peripheral conversion of T4 to T3 by 5’-monodeiodinase

206
Q

When should you start rabies PEP?

A

If it is a high risk risk animal that is caught and tests positive, or if the animal is not able to be observed

207
Q

What should all pts that come in with asthma exacerbation receive?

A

> inhaled SABA (albuterol)
+/- ipratropium
systemic glucocorticoid

208
Q

Treatment of high altitude illness

A

Acetazolamide (carbonic anhydrase inhibitor, blocks reabsorption in the proximal tubule)

**accelerates HCO3 excretion in the urine

209
Q

Management of opioid withdrawal

A

> opioid agonist: methadone or buprenorphine

>nonopioid: clonidine or adjunctive medications (antiemetics, antidiarrheals, benzos)

210
Q

Diagnosis of Echinococcus granulosus (2)

A

> large, smooth hydatid cyst often with internal septations on imaging
IgG serology

211
Q

What are typical symptoms of Paget disease of bone? (4)

A

> bone pain
headaches
unilateral hearing loss
femoral bowing

** all this happens due to osteoclast dysfunction

212
Q

Treatment of spontaneous bacterial peritonitis

A

> empiric abx: third gen cephalosporins

>fluoroquinolones for SBP prophylaxis

213
Q

Treatment for autoimmune hepatitis

A

glucocorticoids +/- azathioprine

214
Q

Clinical manifestations of bacillary angiomatosis (3)

A

> vascular cutaneous lesions (papular, nodular, peduncular)
systemic symptoms (fever, night sweats, fatigue)
organ involvement rarely (liver, bone, CNS)

215
Q

Initial treatment for hyperthyroidism

A

beta blockers to control heart rate and hyperadrenergic symptoms

216
Q

What is first line treatment for Alzheimers?

A

Cholinesterase inhibitors (donepezil, galantamine, and rivastigmine for mild to moderate)

**memantine for moderate to severe (NMDA inhibitor)

217
Q

What lab value is an independent predictor of mortality in pts with HFrEF?

A

hyponatremia

** <130 have an estimated 1 year survival as low as 15%

218
Q

What is initial management in a pt with Meniere disease?

A

sodium, caffeine, nicotine, and alcohol restriction

219
Q

What are the two most common symptoms in ALS?

A

> asymmetric limb weakness

>bulbar symptoms (dysarthria, dysphagia)

220
Q

Clinical manifestations of CVID (4)

A

> recurrent respiratory infections
recurrent GI infections (salmonella, campy, GIARDIA)
Chronic diseases
Doesn’t respond to vaccines

221
Q

Clinical findings in osmotic diarrhea (3)

A

> high osmolar gap (>125)
diarrhea occurs after ingestion of the causative substance
does not occur during fasting

222
Q

Clinical findings in secretory diarrhea (3)

A

> low osmolar gap (<50)
diarrhea is typically large volume
diarrhea persists while fasting and at night

223
Q

Where do Pancoast tumors arise in the body?

A

Apical pleuropulmonary groove

224
Q

Indications for aortic valve replacement (4)

A

> severe AS + one of the following:

  • onset of symptoms (angina, syncope)
  • left ventricular ejection fraction <50%
  • undergoing other cardiac surgery (CABG)
225
Q

What is the most common complication of acromegalic cardiomyopathy?

A

left ventricular aneurysm

226
Q

When will cannon A waves be seen?

A

These waves can be seen with any arrhythmia involving atrioventricular dissociation, complete AV block, and frequent premature ventricular contractions (PVCs)

227
Q

What causes cannon A waves?

A

Caused by the surge of jugular venous pressure that occurs due to right atrial contraction against a closed tricuspid valve

228
Q

What gene is affected in pts with Follicular Lymphoma?

A

(t14;18) leading to overexpression of BCL-2

**oncogene that prevents apoptosis

229
Q

Clinical findings of follicular lymphoma (3)

A

> older pt with months or years of waxing and waning lymphadenopathy
B symptoms and lab abnormalities are rare
mediastinal/hilar lymphadenopathy is sometimes seen

230
Q

Clinical findings in Lewy body dementia (3)

A

> history of periodic confusion
visual hallucinations
parkinsonian motor symptoms

231
Q

What would be seen on brain biopsy in a pt with Lewy body dementia?

A

Eosinophilic intracytoplasmic inclusions representing accumulation of alpha-synuclein protein, may be seen in neurons of the substantia nigra, locus coeruleus, dorsal raphe nucleus, and substantia innominata

232
Q

What class of antihypertensive agents is associated with weight gain and worsening glucose tolerance?

A

> beta blockers

**alpha-1 receptors go unopposed, causing vasoconstriction, which reduces glucose uptake into skeletal muscles

**carvedilol, labetalol have vasodilatory alpha-1 receptor blocking properties and do not cause this issue

233
Q

What are the mucin producing tumors and what can they cause?

A

> Pancreatic, gastric, ovarian, breast

>they secrete tissue factor into the blood which can lead to DIC

234
Q

What is D-xylose used to measure?

A

Used to measure proximal small intestine absorption

** if it is low then there is an issue with absorption (eg celiac)

** if it is high then that can point towards an enzyme deficiency (eg lactose intolerance)

235
Q

Which lab value is tested for to diagnose rhabodo?

A

serum creatine phosphokinase

236
Q

What are two big complications of giant cell arteritis?

A

> permanent vision loss

>aortic aneurysm due to large-vessel involvement

237
Q

What are useful tests for evaluating factitious diarrhea? (3)

A

> stool osmolality
stool electrolyte
stool osmotic gap

238
Q

Treatment for Paget disease of bone

A

> bisphosphonates

239
Q

What is the best way to prevent febrile nonhemolytic transfusion reaction from occurring?

A

> using leukoreduced blood products

240
Q

Treatment progression for a pt with hyperthyroidism

A
  1. beta blockers
  2. methimazole or PTU
  3. radioactive iodine therapy
241
Q

What is the LAP score used to distinguish between?

A 
high = leukemoid reaction
low = CML
242
Q

What are the alternate treatments for syphilis?

A

> Doxycycline (14 or 28 days if late latent or tertiary)

>ceftriaxone (14 days if neurosyphilis)

243
Q

What is the “rare disease assumption”?

A

in a case control study, if the outcome is uncommon in the population, the odds ratio is a close approximation of the relative risk

244
Q

What is the MCC of AA amyloidosis?

A

long-standing rheumatoid arthritis

245
Q

What are the two MCC of a singular brain abscess?

A

> viridans streptococci
Staph aureus

** these usually result from direct extension of an adjacent tissue infection (otitis media, sinusitis, dental infection)

246
Q

Treatment for brain abscess

A

> aspiration/surgical drainage

>prolonged antibiotic therapy (ceftriaxone, vanco, metro)

247
Q

How long can heterophile test be negative in a pt with EBV mono?

A

25% false-negative rate during the 1st week of illness so this test cannot be used to rule out the diagnosis

248
Q

What should be checked for in the serum of all pts suspected of having GPA?

A

antineutrophil cytoplasmic antibodies (ANCA)

  • **c-ANCA is most commonly positive in GPA
  • **p-ANCA more common in microscopic polyangiitis and EGPA
249
Q

Treatment of Myasthenic crisis?

A

> intubation for deteriorating respiratory status

>plasmapheresis or IVIG as well as corticosteroids

250
Q

Empiric antibiotics for pts age 2-50 with bacterial meningitis

A

Vanco + 3rd gen cephalosporin

251
Q

Empiric antibiotics for pts age >50 with bacterial meningitis?

A

Vanco + ampicillin + 3rd gen cephalosporin

252
Q

Empiric antibiotics for immunocompromised pts with bacterial meningitis?

A

Vanco + ampicillin + cefepime

253
Q

Lab findings in pts with polycythemia vera (4)

A

> elevated hemoglobin
leukocytosis and thrombocytosis
low EPO levels
JAK2 mutation

254
Q

When should steroids be given to pts with PCP pneumonia? (3)

A

> pulse ox <92%
PaO2 <70
alveolar-arterial gradient >35 on room air

***antiretroviral therapy should also be started within 2 weeks

Uworld Step 2 (2 decks)

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