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UWorld Step 2 > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

What mediates the corneal reflex?

What specific nerve?

A

CN V1

Nasociliary n. off the ophthalmic branch

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2
Q

What is the MC cause of parietal lobe hemorrhage?

D/T what?

A

Amyloid angiopathy

Cerebral amyloid angiopathy —> AD

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3
Q

Pt w/elevated HTN after being on 3+ anti-HTN meds has what?

If they have ABD bruit?

A

Secondary HTN

Renovascular HTN

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4
Q

Tremor frequency of Parkinson’s?

What med to treat?

A

4-5 Hz

Trihexyphenidyl

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5
Q

Pt that has cough w/daily large volume (> 100 mL/day) mucopurulent sputum, rhinosinusitis, dyspnea, hemoptysis, crackles, wheezing has what?

Dx how?

A

Bronchiectasis

High Res CT

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6
Q

Risk is the probability of getting a disease over time, what is the equation?

A

disease / total # at risk

A / (A+C)

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7
Q

Pt w/increased JVP, Kussmaul’s sign, pulsus paradoxus, with a JVP tracing showing prominent x & y descents has what?

A

Constrictive pericarditis

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9
Q

Young female pt in 20s/30s w/conductive hearing loss and abnormal Rinne test has what?

A

Otosclerosis

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10
Q

Pt w/pigmented skin, increased LFTs, erectile dysfx, hyperglycemia and cardiomyopathy has what?

A

Hereditary hemochromatosis

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11
Q

EKG of pt w/hypokalemia?

A

Broad flat T waves, U waves, ST depression, Premature Ventricular beats

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12
Q

Pt w/Diplopia, tinnitus, HA, neuropathy and HSM, anemia, and thrombocytopenia has what?

A

Waldenstrom’s

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13
Q

Pt w/PMHx of Hodgkin Lymphoma can get what?

MC form with malignancy?

A

Minimal change disease

Membranous nephropathy

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14
Q

Pt that has CKD and taking EPO can have what occur?

A

HTN crisis

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15
Q

Pt having brain hemorrhage and is on warfarin, how to treat?

A

Prothrombin complex concentration and Vit K

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15
Q

What is the MC form of PSVT?

What increases Parasympathetic tone which can result in slowing of conduction in AV node?

A

AV nodal re-entrant tachycardia (AVNRT)

Vagaries maneuvers

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16
Q

How to Dx lactose intolerance?

Stool shows what?

Osmotic gap?

A

+ Hydrogen breath test

+ for reducing substances
low pH

Increased

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17
Q

Pt w/trigeminal neuralgia 3 months ago, uri 2 weeks ago may have what?

A

M.S.

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18
Q

What med SE causes diarrhea, leukopenia, hepatoxicity?

MOA?

A

Azathioprine

Inhibits purine synthesis (6-MP)

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20
Q

What causes peripheral edema, ascites, elevated JVP w/clear lungs?

D/t what?

What 2 special signs?

A

RHF

Constrictive pericarditis

Prominent y descent, Hepatojugular reflex

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21
Q

Pt on vent with ARDS, what is the goal PaO2?

Corresponds to what % O2 sat?

A

55-80

88-95

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22
Q

Narrowing of joint space and Osteophytes is found in what?

A

Osteoarthritis

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23
Q

What is characterized by proximal muscle weakness in the setting of hyperparathyroidism?

A

Chronic hyperthyroid myopathy

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24
Q

Pt has ruby colored papules on his lips that blanch with pressure, digital clubbin, nosebleeds, mucosal lesions in mouth has what?

What other sx?

A

Osler-Weber-Rendu

AVMs
Inc hematocrit

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25
Q

What causes progressive painless muscle weakness predom involving the proximal muscles?

D/t what?

A

Myopathy in Cushing syndrome

Muscle atrophy d/t catabolic effects of cortisol on skeletal m.

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25
Q

Immunocompromised pt w/fever, pleuritic chest pain, hemoptysis has what?

Treat how?

A

Invasive aspergillosis

Voriconazole and echinocandin

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26
Q

What is hyposthenuria?

Commin whom?

A

Inability to [ ] urine, causes nocturnal

Sickle cell pt

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27
Q

What dietary recommendations for pts w/renal stones?

A

Inc fluids
Dec Na
Normal dietary Ca

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28
Q

What pts should get the PCV12 and PPSV23 if they are under 65 y/o?

A

Heart, lung, or liver disease

Or have DM, smoke, or EtOH user

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30
Q

How does acromegaly affect the structure of the heart?

What else can it cause?

A

Concentric myocardial hypertrophic, LV dilation, global hypokinesis

Flail mitral leaflet —> MR

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31
Q

What is another name for biliary colic?

Lasts how long?

What sx?
What negative sx?

A

Hollow organ contraction and outlet obstruction

< 6 hours, resolves completely

Epigastric and Right shoulder pain, Vomitting
NO fever, NO ABD pain, NO leukocytosis

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32
Q

OR equation?

A

Ad / bc

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32
Q

What is the path behind NPH?

A

Dec CSF absorption

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35
Q

What is Felty Syndrome?

Dx how?

A

Inflammatory RA, neutropenia, splenomegaly

Anti-CCP and RF +, ESR > 85

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36
Q

Pronator drift is a finding in what path?

What disease?

A

UMN or pyramidal/corticospinal tract disease

M.S.

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37
Q

Anorexic pt w/elevated urine Na w/ortho HoTN, HypoNa, hypoK is doing what?

A

Abusing diuretics

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38
Q

Pt w/vitiligo may also have what?

A

Pernicious anemia, primary AI, RA, Sjogren’s, Hashimoto’s, Graves

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38
Q

Colonoscopy that reveals dark brown mucosal pigment in the proximal colon has what?

Caused by what?

Histology shows what?

A

Melanosis coli

Months of regular laxative ingestion

Pigment in the macrophages of the LP

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39
Q

Pt w/ABD sx and cannot absorb D-xylose has what?

Pt normal d-xylose test?

A

Celiac

Chronic pancreatitis

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40
Q

What treats ethylene glycol poisoning?

Labs show what?

A

Fomepizole

HypoCa
Calcium oxalate kidney stones

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42
Q

Pt w/a history of 1 year of foul-smelling diarrhea, weight loss, fatigue will have what?

Can cause what?

A

Vit D deficiency

Hypocalcemia, dec PO4 level

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42
Q

Old (senior citizen) w/dementia attack treat how?

A

Haldol

Don’t use BENZO

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43
Q

Pt w/HIV, fever, cough, dyspnea most likely has what?

A

PCP

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43
Q

Cushing Syndrome can cause what ob-gyn irregularities?

A

Irregular periods

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45
Q

Glucocorticoid induced myopathy ESR level?

CK?

A

Both normal

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47
Q

What is the MC cause of MVP?

A

Myxomatosis degen of mitral valve leaflets and chordate

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48
Q

PBC presents w/what clinical feature?

Associated w/what diseases?

A

Eye xanthelasmas

HCC
Osteomalacia
Osteoporosis

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48
Q

Carcinoid syndrome causes a deficiency of what vitamin?

A

Niacin

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50
Q

What is the #1 cause of Asymptomatic rise in ALP in old people?

Path?

What labs?

Imaging?

A

Paget disease of bone

Osteoclasts dysfx, inc bone turnover

Elevated ALP, PINP, hydroxyproline

Bone scan - focal increase uptake
Xray - osteolytic or mixed lesions

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51
Q

Women on oral Estrogen therapy require more/less dose levothyroxine for hypothyroid?

Why?

What will be inc/Dec?

A

MORE

Estrogen dec clearance of TBG —> inc TBG levels

Dec free T4, Total T4 will be normal/inc
Inc TSH

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52
Q

What presents w/acute, severe MR, HoTN, pulmonary edema, SOFT murmur?

A

Papillary muscle rupture

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53
Q

CHF presents w/what acid-base status?

CO2 level?

A

Alkalosis

Low CO2

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54
Q

Pain in the knee caused by abnormal gait, overuse or trauma is what?

Located where?

A

Pes anserinus

Bursa inflamed located anteromedially over the tibia plateau

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56
Q

Diabetic foot ulcers cause what kind of infection?

How?

A

Polymicrobial

Contiguous spread

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57
Q

Cancer-related anorexia/cachexia is a _______ state?

What can treat it?

A

Hypercatabolic

Progesterone analogs - megestrol acetate

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57
Q

Bitter almond odor = ?

A

CN toxicity

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58
Q

Anti-Phospholipid Ab Syndrome has what abnormal lab value?

What specific tests?

A

Prolonged PTT

Russell viper venom test, kaolin clothing time

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59
Q

Pt that has COPD and develops neurologic sx after admin of O2 has what as the cause?

A

CO2 retention

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61
Q

Hydroxychloroquine treats what?

SE?

A

SLE

Retinal toxicity

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62
Q

Travel to North Africa, what vaccines do you need?

What about sub-Saharan Africa/South America?

A

HepA, HepB, Typhoid, polio booster

Yellow fever

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63
Q

What meds can treat restless leg syndrome?

MOA?

A

Pramipexole and gabapentin

Dopamine agonists

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63
Q

EKG of HOCM looks like what?

A

Tall R wave in aVL, deep S wave in V3

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64
Q

Pt in their 30s or 40s w/HTN, hematuria, proteinuria, and progressive renal insufficiency has what?

A

ADPKD

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65
Q

Presbycusis causes what?

A

Sensorineural hearing loss

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66
Q

What DM drug causes weight loss?

A

GLP-1 agonists - the “tides”

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67
Q

HIV pt w/subacute-onset of low-grade fever, HA, inc ICP has what?

A

Cryptococcus

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67
Q

What can cause a false positive for VDRL testing for syphilis?

A

Anti-phospholipid Ab syndrome

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68
Q

What causes autoAbs directed against VG calcium channels in the presynaptic motor nerve terminal?

Causes what sx?

A

Lambert-Eaton d/t small cell lung CA

Symmetric proximal muscle weakness w/depressed DTRs

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68
Q

How do OCP’s effect TBG?

total T4?

free T4?

TSH?

A

Inc TBG bc of inc estrogen

Inc

Same

Same

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69
Q

What causes a cres-decrescendo murmur that INC on inspiration?

Dx how?

Treat how?

A

PV stenosis

Echocardiogram

Percutaneous balloon valvulotomy

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70
Q

How does AV fistula Cardiac preload?

Causes what?

A

Inc

High-output cardiac failure

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70
Q

Well-circumscribed, raised erythematous plaques, lesions can be oval or round w/intense pruritis that lasts for less than 6 weeks is what?

A

Acute uticaria

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71
Q

PCT assoc w/what other conditions?

A

HepC, HIV, EtOH, smoking, estrogens

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72
Q

How does polymyositis present?

A

Slowly progressive proximal muscle weakness of the LE then UE

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73
Q

PAS+ and anything to wit the stomach = ?

Sx?

A

Whipple’s

Arthralgia, weight loss, fever, diarrhea, ABD pain

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74
Q

Pt w/unilateral testicular pain, epididymal edema, dysuria has what?

If > 35, d/t what?
Under 35?

Treatment?

A

Acute epididymitis

E. Coli
STI

Ceftriaxone/Doxycycline

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75
Q

What is the earliest renal abnormality in pts w/DM?

What is the 1st change that can be quantitated?

A

Glomerular hyperfiltration (ACE-i’s counteract this)

Thickening of the GBM

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75
Q

Where does AFib originate MCly?

Atrial flutter is a reentrant circuit around what?

A

PV

Tricuspid annulus

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76
Q

Albuminocytologic dissociation in CSF means what?

With what Dx?

A

Elevated protein w/normal cell count

GBS

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76
Q

Pressure necrosis occurs where?

Arterial ulcer?

A

Bony prominences - sacrum, ischial tuberosity, Malleoli, 1st and 5th metatarsal head

Tips of toes

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77
Q

Pt w/ACUTE onset odynophagia after an EGD most likely has what?

Dx how?

A

Perforation - prob see bleeding

Gastrografin (water-soluble) contrast esophagram

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78
Q

NAFLD pathophys d/t what?

Have increased what?

A

Insulin resistance

Peripheral lipolysis

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79
Q

Inflammatory arthritis = ?

A

Early RA

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80
Q

Post op patient w/HoTN, JVD, and new-onset RBBB that develops syncope has what?

A

Massive PE

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81
Q

Stroke pt w/Contralateral sensory loss, leg symptoms d/t what pathology?

A

Lacunar stroke of posterolateral thalamus (supplies PCA)

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81
Q

MPGN is d/t what path??

A

Persistent activation of the alternate complement pathway

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82
Q

ARP = ?

A

(RR - 1) / RR

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83
Q

What is the RA pressure (preload) in cardiogenic shock?

PCWP?

Cardiac index (pump fx)?

SVR?

MvO2?

A

Inc

Inc

Dec

Inc

Dec

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84
Q

What causes a mild, brief hyperthyroid, that is small nontender w/spontaneous recovery?

+ for what?

A

Painless thyroiditis

TPO

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84
Q

Pt w/acute onset of HA, nausea, blurry vision, sluggish/dilated pupil has what?

Caused by what?

A

Acute angle glaucoma

Trihexyphenidyl (anti-ACh)

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87
Q

Polymyositis has what CK?

What ESR?

A

Inc

Inc

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87
Q

What presents w/acute, diffuse, non-inflammatory hair loss that is self limiting?

What is the transformative phase?

Rest/shedding phase?

A

Telogen effluvium

Anagen

Telogen

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88
Q

What can cause theophylline toxicity?

Sx?

A

Cirrhosis, cholestasis, resp infection, ciprofloxacin

CNS stimulation, N/V, cardiac toxicity

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89
Q

What does P mitrale look like on EKG?

A

Broad and notched P waves, RVH, atrial tachyarrhythmias

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89
Q

Pt that develops acute onset speech arrest and weakness has what?

Imaging shows what?

Treat how?

A

TIA

NonCon CT of head will be -

ASA, statin, BP control

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90
Q

Stool osmotic gap = ?

A

290 - [2*(Na + K)]

> 50 means osmotic diarrhea

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91
Q

Female pt in her 30’s with optic neuritis and numbness/parasthesia w/motor paraparesis and spasticity has what?

Dx how?

A

M.S.

MRI brain or Oligoclonal IgG bands on CSF

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92
Q

How long does a fat embolism take to manifest?

A

12-24 hours

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93
Q

Pt that presents with STIFF shoulder, decreased passive and active ROM and POOP?

A

Adhesive capsulitis

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93
Q

Path behind sympathetic ophthalmia?

What is it?

A

Uncovering hidden Ags

Immune-mediated inflammation of 1 eye after a penetrating injury to the other eye

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94
Q

What can cause saline-unresponsive metabolic alkalosis?

Presents how?

A

Self-induced vomiting

Urinary chloride > 20 mEq/L

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94
Q

Zinc is absorbed where?

Deficiency can be d/t what?

Clinical features?

A

Duodenum and jejunum

Crohn’s, bowel resection, gastric bypass

Alopecia, hypogonadism, impaired wound healing, impaired taste

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95
Q

Pt that has pancytopenia, increased LDH, prolonged PT and PTT with fatigue has what?

A

AML

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95
Q

SAAH > 1.1 means what?

< 1.1?

A

Portal HTN w/inc hydrostatic pressure

Inc capillary permeability (pancreatitis, nephrotic syndrome, TB)

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96
Q

How to treat bacillary angiomatosis in HIV pts?

A

Doxycycline or erythromycin

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97
Q

Trastuzumab SE?

A

Cardiotoxicity - decline in LV EF

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98
Q

RR equation?

A

[a / (a+b)] / [c / (c+d)]

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99
Q

Does CML have a decreased or increased LAP score?

A

Dec

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99
Q

Acute phase of ASA intox?

Chronic?

CO2 level?
HCO3 level?

pH?

A

Resp alkalosis

AG metabolic acidosis

Low
Low
Close to normal bc mixed pic

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101
Q

Isolated systolic HTN defined how?

PATH?

A

systolic BP > 140 w/diastolic BP < 90

Inc stiffness or dec elasticity of aortic end arterial walls

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103
Q

when does a LV aneurysm occur?

Presents how?

A

5 days - 3 months

Persistent ST elevation, Deep Q waves

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104
Q

MOA of sublingual nitro?

A

Decreased LV wall stress

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105
Q

What can you do to shift K+ into cells?

A

Insulin and glucose

Calcium gluconate or CaCl

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105
Q

What can result from hyperextension in a MVA?

CF?

A

Central cord syndrome

Weakness in the UE > LE
Localized deficit in pain/temp

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106
Q

Achalasia is d/t what path?

A

Loss of intramural neurons

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106
Q

Painless blisters, bullae, scarring, hypopigmentation on sun-exposed areas, and scarring is d/t what?

A

Porphyria cutanea tarda

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107
Q

Pain that is worse on an empty stomach, epigastric pain w/melena = ?

D/t what?

A

Duodenal ulcer

H pylori or NSAID

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108
Q

What causes a normocytic anemia, splenomegaly, reticulocytosis, jaundice w/elevated indirect bilirubin, inc LDH, dec haptoglobin?

A

Autoimmune hemolytic anemia

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109
Q

What causes excessive collagen deposition in the peri-alveolar tissues?

DLCO is what?

A-a gradient?

A

IPF

Dec

Inc

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110
Q

What presents w/fever, superficial dermis infection w/sharply demarcated raised edges that rapidly spreads?

MC organism

A

Erysipelas

Strep pyogenes

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111
Q

What can glucocorticoids cause?

Describe?

A

Drug-induced acne

Monomorphic papules w/out comedones, cysts, or nodules

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111
Q

Low-voltage EKG w/electrical alternans

A

Cardiac tamponade

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111
Q

What presents w/fever, rash that involves the palms and soles and is diffuse throughout the body, and HoTN?

A

Toxic shock syndrome

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115
Q

What vaccine works by relatively T-cell independent B cell response?

A

PPSV23 PNA vaccine

Jordan is independent, don’t need no help

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116
Q

Pt w/fever, ABD distention, leukocytosis, HoTN, tachycardia has what?

Dx how.

A

Toxic megacolon

ABD xray shows colon distended > 6 cm

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116
Q

Cross sectional study is what kind?

Estimates what?

Examines what?

A

Observational

Prevalence

Associations bw RF

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117
Q

PCP treated how?

Add steroids if?

A

Bactrim

PaO2 = 70 or A-a gradient >/= 35

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118
Q

Pt with urinary retention can be confirmed how?

A

Bladder US w/urine > 300 mL

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119
Q

What is the RA pressure (preload) in hypovolemic shock?

PCWP?

Cardiac index (pump fx)?

SVR?

MvO2?

A

Dec

Dec

Dec

Inc

Dec

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120
Q

Systemic amyloidosis can effect the heart how?

A

Restrictive cardiomyopathy w/low voltage

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120
Q

Pt w/prolonged fever, malaise, exudative pharyngitis, HSM and generalized LAD has what?

Can develop what after 2-3 weeks?

A

Infectious mono

Autoimmune hemolytic anemia, thrombocytopenia

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122
Q

How do you treat cocaine OD?

A

IV Benzo

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122
Q

Pt w/DVT in the setting of elevated homocysteine needs to be on what?

A

Pyridoxine - B6

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123
Q

Pregnant mom’s get what MSK path?

Effects what muscles?

A

De Quervain tenosynovitis

APL and EPB

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125
Q

AR has what Inc/dec LV EDV?

LV ED pressure?

What signs and symptoms?

A

Inc

Inc

Diastolic decrescendo murmur, widened PP

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125
Q

What is an abscess over the eyelid d/t staph aureus and appears localized red w/tender swelling?

A

Hordeolum

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127
Q

NON-healing, painless, bleeding skin ulcer suggests what?

Do what?

A

SCC

Biopsy

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128
Q

Cryptosporidium parvum can cause what in non-HIV pts?

A

Traveler’s diarrhea, found in lakes and streams

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128
Q

Right ventricle MI supplied by what vessel?

EKG changes?

A

RCA

ST elevation in V4-V6

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130
Q

What presents w/deep dermal infection w/no fever at the beginning, flat edges, over a few days?

MC organism?

A

Cellulitis

S pyogenes, MSSA

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131
Q

What is electrical alternans mean on EKG?

A

QRS in the SAME lead is of different amplitude

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131
Q

Wernicke’s area is located where?

A

Superior temporal gyrus of temporal lobe

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132
Q

Humoral hypercalcemia of malignancy is the MC of what?

Presents how?

A

PTHrP secretion

Ca > 14 with smoking pmhx

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133
Q

Direct renin inhibitor causes what?

Effects angiotensin II how?

Aldosterone?

A

Enhanced natriuresis

Dec

Dec

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133
Q

What is a very bad sign in a pt with acute asthma exacerbation?

What should they have?

A

Normal PaCO2

Very low bc of hyperventilation

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133
Q

What deficiency is common after partial or total gastrectomy?

Causes what?

A

B12

Defective DNA synthesis

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134
Q

Paget disease of bone alternate name?

A

Osteitis deformans

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134
Q

What presents w/alternating hypoglossal hemiplegia w/c/L paralysis of arm and leg and tongue deviation towards the lesion and loss of c/L tactile and position sensation?

D/t what?

A

Medial medullary syndrome

Vertebral or anterior spinal artery occlusion

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134
Q

Burr cell seen in what?

A

ESRD and liver disease

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135
Q

Bicuspid aortic valve in young pt can cause what?

Murmur sounds what?

A

AR

Diastolic decrescendo, widened PP, water hammer pulse

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136
Q

Cross sectional study is used to determine what?

A

Prevalence of disease, or to examine associations bw RF

CrAP

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137
Q

What causes erysipelas?

Treat how?

A

Strep pyogenes

Ceftriaxone, cefazolin

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137
Q

What is located in anterior mediastinum?

Middle mediastinum?

Post?

A

Thymoma

Bronchogenic cyst

Leiomyoma, all neurogenic tumors, hernia, AA

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138
Q

Pt w/1st time seizure in adult do what workup?

A

UDS, labs
MRI and CT
EEG

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138
Q

What causes hemi-neglect?

A

Infarct of the non-dominant (MC right) parietal cortex

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139
Q

Pt w/dec FEV1/FVC ratio and normal DLCO has what?

With Dec DLCO?

A

Chronic bronchitis or asthma

Emphysema

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140
Q

Treatment for pulmonary HTN?

A

Diuretics and ACE-i

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141
Q

Exudate pleural effusion has what pathophys?

A

Inc capillary or pleural membrane permeability

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142
Q

Pt that is in the hospital w/UTI then gets IE, what organism?

A

Enterococcus

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142
Q

Path behind tarsal tunnel syndrome?

sx?

A

Compression of Tibial n. As it passes through ankle

Burning, numbness, aching of DISTAL plantar surface

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143
Q

Marian pt w/acute chest pain that causes early decrescendo murmur diastolic murmur along the Left sternal border at the 3rd and 4th ICS has developed what?

A

Acute AR from aortic dissection

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143
Q

Pt w/vomiting and upper ABD pain w/rapid progression to odynophagia, dyspnea, and septic shock with a widened mediastinum?

Diagnose how?

A

Esophageal rupture = Boerhaave Syndrome

CT or contrast EGD w/gastrograffin

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145
Q

What can cause acute erosive gastropathy?

Characterized how?

A

ASA, cocaine, alcohol

Severe hemorrhagic lesions

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146
Q

What can cause abrupt increases in RA pressure to > 10 mmHg and PA pressure to > 40 mmHg?

This leads to what?

A

Massive PE

Dec CO, HoTN, obstructive shock

148
Q

What are the top 5 things to do to lower systolic BP?

A 
1 - weight loss if BMI > 25
DASH diet
Exercise 
Dec dietary Na
EtOH
149
Q

What are the sx of thyrotoxicosis?

How does it affect myocardial contractility?

SVR?

A

Weight loss, tachycardia, tremor, lid retraction

Inc

Dec

150
Q

Pt that has recurrent DVTs must be checked for what?

152
Q

Sudden onset of multiple seborrheic keratosis indicates what?

Means what?

A

Lesar-Trelat sign

Cancer

153
Q

What is the best indicator for cardiac cause of edema?

A

+ hepatojugular reflex

160
Q

What presents as gastric folds protruding above the diaphragm?

A

Hiatal hernia

161
Q

What is the MOA of BB and Non-DHP on the heart?

DHP CCB MOA?

A

Decrease myocardial contractility

Decrease afterload

162
Q

What causes symmetric, migratory, nonerosive w/brief morning stiffness of a pt’s joints?

163
Q

What is the MC type of esophagitis in HIV pts?

A

Infectious

165
Q

Pt that has diverticulitis can develop what?

Presents how?

A

Fistula

Bubbles in the urine —> pneumaturia or fecaluria

166
Q

What categorizes SJS?

TEN?

A

Skin involvement of < 10%

> 30%

167
Q

What is endemic mycosis of central and midwestern US?

Sx?

Dx?

treat?

A

Histo capsulatum

Pancytopenia, febrile, pulm mucocutaneous and reticuloendothelial manifestations

Serum/urine Ag Immunoassay

Amp B, switch to itraconazole after 1-2 weeks

168
Q

What qualifies as acute liver failure

A

LFT > 1000
Hepatic encephalopathy
INR >/= 1.5

1 of the 3

169
Q

How to treat HOCM?

A

BB

Non-DHP CCBs

170
Q

Adult w/erythema infectiousum, symmetric arthralgia, and works in a day care center has what?

172
Q

Pt w/avascular necrosis of hip has MRI showing what?

A

Subchondral lucency -> crescent sign

173
Q

If IIH is not treated, what can it cause?

174
Q

Guatemalan farmer w/HM, RUQ pain and liver cysts has what?

Comes from what?

Treat how?

A

Echinococcus granulosas

Dog tapeworm

Albendazole

176
Q

What medications you need to hold prior to stress testing?

For how long

A

BB
CCB
Nitrates

48 hours

177
Q

Acute MR d/t papillary m. Rupture w/acute MI causes what?

A

Excess volume overload
Inc LA pressure
Inc ventricular filling pressure
Acute Pulm Edema

178
Q

What are the SE of methotrexate?

A

Macrocytosis
Pancytopenia - Bone marrow suppression
Stomatitis
Hepatotoxicity

179
Q

Otoscelerosis causes what?

Otoscopic exam appears how?

A

Progressive CONDUCTIVE hearing loss

Normal

180
Q

Orthostatic HoTN is d/t what?

A

Dec baroreceptor responsiveness

183
Q

What is the RA pressure (preload) in septic shock?

PCWP?

Cardiac index (pump fx)?

SVR?

MvO2?

A

Dec or normal

Dec or normal

Inc

Dec

Inc

185
Q

What is the most sensitive screen for neuropathy in diabetic pts?

A

Random urine for microalbumin/Cr ratio

186
Q

Pt w/Localized chest pain that worsens w/movement and deep inspiration or coughing that is Tender to palpation and is sharp has what?

Treat?

A

Costochondritis

Reassurance

191
Q

Pt w/HTN Emergency treated with what?

potential SE?

Sx?

A

Nitroprusside

CN toxicity

AMS, lactic acidosis, seizure, coma

192
Q

Pt w/septic shock and 1 day later develops AST/ALT elevations has what?

A

Ischemic hepatic injury —> shock liver

193
Q

Lateral epicondylitis has pain with what passively?

Actively?

A

Passive wrist flexion

Active wrist extension

197
Q

B12 deficiency causes what?

Common in what?

A

Glossitis, peripheral neuropathy

Pernicious anemia, gastric cancer

198
Q

What skin lesion arises de novo and will have a central punctum that resolves spontaneously but can recur?

A

Epidermal inclusion cyst (epidermal cyst)

199
Q

What is Cushing’s reflex?

Indicates what?

A

HTN, bradycardia, resp depression

Brain stem compression

201
Q

SE of levodopa/carbidopa?

A

Hallucination, confusion, somnolence…much later dyskinesia

202
Q

What causes tenosynovitis, dermatitis, asymmetric migratory polyarthralgia?

A

Disseminated gonococcal infection

203
Q

Massive PE defined how?

A

HoTN w/Right heart strain
Syncope
RBBB
Elevated RA and PA pressure with normal PCWP

204
Q

Case control studies determine what first?

Retrospective cohorts?

A

Outcome

RF exposure

207
Q

Milk-alkali syndrome causes what changes?

A

Renal vasoconstriction and decreased GFR

Renal loss of Na + H20

208
Q

What are the signs of RV Failure?

What does it cause?

A 
Elevated JVP
RV S3
TR murmur 
HM w/pulsatile liver
LE edema, ascites

Cor Pulmonale

209
Q

Complicated parapneumonic effusion, describe the following: pH?

Glucose?

Wbc?

A

< 7.2

< 60

> 50,000

210
Q

Lynch syndrome is what?

A

CEO
Colon
Endometrial
Ovarian

212
Q

What kind of gait does Parkinsonism have?

A

Hypokinetic gait

214
Q

HIV pt w/SM and elevated ALP level, normal CXR, fever, cough, ABD pain, D, night sweats has what?

A

Disseminated MAC

216
Q

What causes cardiogenic shock physiologically?

A

Impaired LV contractility

218
Q

Pt w/Proximal symmetric muscle weakness in UE and LOE w/inc CK, inc aldolase, inc LDH has what?

A

Dermatomyositis

220
Q

Alanine gets converted to _____ in gluconeogenesis?

221
Q

Pt that presents w/chest pain and dysphagia and manometry showing multiple simultaneous contractions of the middle and lower esophagus has what?

Treat?

222
Q

Dec breath sounds in the lower lobes = ?

If pt is < 45 then most likely what?

A

COPD

alpha 1 anti-trypsin

223
Q

Strawberry hemangioma occurs when? Treat how?

Cherry hemangioma?

A

1st weeks of life, regresses spontaneously by age 5-8

Old people

225
Q

What causes weight loss, diarrhea, anemia, and neurologic migratory erythema?

A

Glucagonoma

226
Q

Pt w/advanced cirrhosis, portal HTN, edema, w/renal hypoperfusion has what?

Path?

Treat how?

A

Hepatorenal syndrome

Splanchnic arterial dilation, dec vascular resistance

Splanchnic vasoconstrictors (midodrine, octreotide, NE)

227
Q

Pt comes in w/DKA, when do you give them bicarbonate?

When to give them PO4?

A

pH < 6.9

< 1.0

228
Q

Pt that has pruritis, elevated Hg, low EPO, HTN and bleeding has what?

Complications?

Treatment?

A

PV

Thrombosis, AML, gout

Phlebotomy, Hydroxyurea

231
Q

What is the path behind osteomalacia?

Seen in what common disease?

ALP is what?

PTH?

Vit D?

A

Impaired osteoid matrix mineralization

Celiac spruce

Inc

Inc

Dec

232
Q

Correcting hypernatremia too quickly can cause what?

A

Cerebral edema

233
Q

What is characterized by rapidly progressive ascending paralysis, absence of fever or sensory abnormalities and normal CSF exam in a pt that was in Colorado?

A

Tick-borne paralysis

235
Q

Episodic, painless GI bleeding dark maroon in color in an older pt w/AS has what?

A

Angio dysplasia

237
Q

Pulsus paradoxus during inspiration can indicate what?

A

Severe asthma or COPD

238
Q

Pt w/HTN that is old and suddenly presents w/weakness aka pure motor hemiparesis has what?

A

Lacunar stroke

240
Q

What disease predispose to Kidney Amyloidosis?
See what symptoms?

What histology on imaging?

A

R.A. And IBD
Enlarged kidneys, hepatomegaly

Glomerular deposits after special staining

241
Q

What is the pathology behind Graves ophthalmopathy?

A

Activated T cells and Thyrotropin Receptor Antibodies

244
Q

S3 d/t what?

S4?

A

Heart Failure, restrictive cardiomyopathy

Atrial Gallup, d/t acute MI, LV stiffening

245
Q

Hard, nontender, u/L in the neck are very suspicious for what?

A

SCC of neck

246
Q

Mucus plugging = ?

Breath sounds?

Mediastinal shift?

A

Atelectasis

Dec

Towards atelectasis

247
Q

Dermatitis herpetiformis may occur where on body?

A

Elbow, knee, back, butt

248
Q

COPD home oxygen supplementation if what?

A

PaO2 is 55 and lower OR SaO2 is 88 and lower

SaO2 is 89 in pts w/Cor pulmonale, RHF or Hct > 55

252
Q

What presents w/triad of fever, leukocytes, LUQ pain w/left-sided pleuritic chest pain?

MC cause?

A

Splenic abscess

IE

253
Q

Renal V thrombosis is a complication of what?

MC d/t what?

A

nephrotic syndrome

Membranous glomerulopathy

254
Q

SE of Amantadine?

A

Ankle edema

Livedo reticularis

256
Q

What is the #1 RF for stroke?

257
Q

Cor Pulmonale is diagnosed definitively by what?

A

Elevated PA systolic pressure > 25

258
Q

What presents w/nonhealing ulcers, livedo reticularis, recurrent sinusitis/otitis and lung nodules?

A

Wegener’s

259
Q

Acute DVT/PE can be treated w/what alternate therapy?

Onset?

A

Apixaban or Rivaroxaban

2-4 hours

260
Q

How long does a subacute cough last for?

Path?

Treat?

A

3-8 weeks

PND

1st gen antihistamine

261
Q

When does febrile nonhemolytic transfusion reaction occur?

Sx?

How to prevent?

A

1-6 hours

Fever, chills, malaise, NO hemolysis

Leukoreduction

262
Q

Cortical laminar necrosis indicates what?

A

Prolonged seizures

263
Q

What presents w/a new harsh holosystolic murmur w/palpable thrill at the Left sternal border and pt has HoTN?

Occurs when?

A

Rupture of IV septum 3-5 days post Acute MI

265
Q

Pt w/extreme pain after surgery and not responding to toradol give what?

When is toradol’s peak effectiveness?

A

Morphine

3 hours

266
Q

What meds for migraine prophylaxis?

A

Topiramate - blocks VG Na and Ca channels
Divalproex Na
TCA
Propanolol

267
Q

What presents w/LAD, pancytopenia, HSM, common in Mississippi?

A

Histoplasmosis

268
Q

Hepatojugular reflex is used to differentiate bw what?

A

Cardiac v liver causes of LE edema

Cardiac = + HJ reflex

270
Q

CHF d/t dilated cardiomyopathy Echo will show?

A

Dilated ventricles and diffuse hypokinesia —> Low EF

274
Q

Brain abscess w/SINGLE ring-enhancing lesion DDx?

A

Staph aureus

Viridans Streptococci

275
Q

Meth use is assoc w/what?

Causes what sx?

Treat?

A

Cardiomyopathy

HF, HoTN, low pulses, low CO, cool UE/LE

Dobutamine

279
Q

Pt that has a HA, Low-grade fever, periorbital edema, vomiting, papilledema, after an insect bite may have what?

A

Cavernous sinus thrombosis

281
Q

High dose acyclovir can cause what?

A

Crystalluria w/renal tubular obstruction

282
Q

What technique used in case-control studies is designed to eliminate confounding?

283
Q

Plateau pressure = what?

A

Elastic pressure + PEEP

284
Q

Pt w/jaundice, icterus, + urine bilirubin assay has what build up?

If + urine urobilinogen assay then what?

A

Conjugated bili

Unconjugated

287
Q

What can cause a stone to be stuck in the common BD?

Treat how?

A

Postcholecystectomy syndrome

ERCP

288
Q

Inferior MI supplied by what vessel?

Sx?

A

RCA

HoTN, bradycardia, AV block

289
Q

What causes b/l hemiparesis/weakness, diminished b/l pain and temp 1-2 levels below injury and INTACT b/l 2pt proprioception?

A

Anterior spinal cord syndrome

291
Q

Pt w/caustic ingestion needs what w/in 24 hours?

A

Upper EGD w/water soluble contrast

293
Q

SE of radioactive iodine?

PTU?

Methimazole?

A

Worsens ophthalmopathy, permanent hypoT

Hepatic failure, ANCA-Vasculitis

Cholestasis

294
Q

Ethylene glycol damages what organ?

Methanol?

A

Kidney

Eyes - optic disc hyperemia

295
Q

WPW causes what on EKG?

A 
Short PR interval (< .12s)
Delta wave
QRS widening (> .12s)
296
Q

Pt w/symmetrically enlarged NonTender thyroid w/elevated TSH and normal T4 has what?

Path?

A

Subclinical hypothyroid

Anti-TPO Abs
Can cause recurrent pregnancy loss

297
Q

Pt w/LE that has pain, pallor, paresthesia, no pulse, and paralysis has what?

D/T what?

Treat how?

A

Acute arterial occlusion

AFib - thrombus

Heparin drip

298
Q

Polymyalgia rheumatica CK level?

ESR?

Sx?

A

Normal

Elevated

STIFFNESS, esp in the morning, lasts > 1 hour

299
Q

Posterior MI supplied by what vessel?

What on ekg?

A

LCX

ST depression in V1-V3
ST elevation in I and aVL

300
Q

HTN vasculopathy causes what?

A

Bleed in the basal ganglia

304
Q

What causes retinal hemorrhages, papilledema, or encephalopathy?

A

Malignant HTN

306
Q

What med SE causes nephrotoxicity, hyperK, HTN, tremor?

MOA?

A

Tacrolimus

Inhibits IL-2

307
Q

Diuretics, baby ASA, surgery, trauma, recent hospitalization puts pt at risk for what?

308
Q

Pt w/PCN allergy should be treated with what?

Unless what?

A

Doxycycline

Pregnancy or tertiary syphilis

309
Q

Pt w/anemia, leukopenia, thrombocytopenia, low complement levels and joint pain has what?

310
Q

What causes LE swelling that is worse in the evening and prolonged standing, is improved w/leg elevation and after walking, will see pitting edema?

Treat?

A

Chronic venous insufficiency causes venous HTN in deep veins of legs

RICE

311
Q

Causes of glomerular hematuria?

Which is greater: microscopic or gross?

A

Post-strep, IgA nephropathy, Alports

Microscopic

312
Q

Treat Raynaud’s phenomenon?

A

CCB - amlodipine / nifedipine

313
Q

What are some things that can trigger thyroid storm?

A 
Surgery
Infection
Trauma
Iodine contrast
Childbirth
314
Q

HIV pt that gets acute retinal necrosis w/pain, keratitis, uveitis and peripheral pale lesions has what?

315
Q

Type 4 RTA has what K+?

Common in what pts>

A

Hyperkalemia

Poorly controlled diabetes, HTN

316
Q

If a disease has low prevalence, what is the incidence?

317
Q

Pt w/ophthalmic exam that shows grey, elevated retina and sx of photopsia, floaters and “curtain coming down” has what?

A

Retinal detachment

318
Q

Inability to lift the skin on the dorsum of the second toe is called what?

Specific for what?

A

+ Stemmer sign

Lymphedema

319
Q

Does TR increase or decrease on inspiration?

320
Q

What causes nontender enlargement of the submandibular glands that is non inflammatory?

A

Sialadenitis

321
Q

Hemochromatosis can cause what joint problems?

A

Pseudogout —> chondrocalcinosis

323
Q

What is peak airway pressure aka?

= what?

A

Max TV being delivered

Resistive pressure (flow x resistance) + Plateau pressure

324
Q

MC skin cancer in immunosuppressed?

2nd?

A

SCC

Melanoma

327
Q

Upright CXR w/free air under the diaphragm means what?

A

Perforation

328
Q

Pt that presents w/PNA, fever, bradycardia and GI symptoms has what?

Treat how?

A

Legionella

Resp FQ - Levaquin or moxifloxacin

329
Q

Elevated testosterone and normal DHEAS indicates what?

Elevated DHEAS?

A

Ovarian source

Adrenal source

331
Q

What can cause venous compression w/distended neck veins and facial plethora?

What is this called?

A

Retrosternal extension —> thyroid lymphoma

Pemberton sign

332
Q

Cell-mediated important in what kidney path?

Non-immune kidney damage for what?

A

Crescent GN

Diabetic and HTN nephropathy

333
Q

Pathophys of S4 heart sound?

A

Stiff LV, restrictive cardiomyopathy, LVH, prolonged HTN

334
Q

Pt on warfarin with back pain and hemodynamic instability at risk for what?

A

Retroperitoneal hematoma

335
Q

Protein of 3+ on dipstick means how much in urine?

A

300-1000 mg/dL

336
Q

2nd degree type 1 AV block is what?

Describe

A

Wencekbach

Prolonged PR interval and dropped beat

337
Q

Treatment for a disease when standard therapy fails is called what?

Example?

A

Salvage therapy

Radiation therapy for prostate recurrence after prostatectomy for cancer

339
Q

Pt w/pmhx of total Nephrectomy can get what?

A

U/L obstructive uropathy d/t renal calculus

343
Q

What is euthyroid sick syndrome?

A

Normal TSH
Normal T4
Low T3

344
Q

What causes a holosystolic murmur which is the result of a permanent pacemaker?

346
Q

GVHD is d/t activation of what?

A

Donor T lymphocytes

347
Q

What presents w/rapid dementia and MYOCLONUS?

What special sign on EEG?

A

CJD

Triphasic synchronous discharge on EEG

348
Q

What is the Path of DM?

What type of symptoms does this path produce?

A

Axonopathy of LARGE nerve fibers

  • sx (numbness, loss of proprioception and vibration, diminished ankle reflexes)
351
Q

What types of strep belong to the viridans group?

A 
Sanguinis
Sobrinus
Mitis
Milleri
Mutans
Oralis
353
Q

What can cause methemoglobinemia?

Treat how?

A

Dapsone or anesthetic agent

Methylene blue

354
Q

How are the breath sounds on consolidation (lobar PNA)?

Tactile fremitus?

Percussion?

A

INCREASED

Increased

Dull

355
Q

Pearly nodule on face w/elevated or rolled border w/central ulceration is what?

356
Q

What causes widened pulse pressure, strong peripheral arterial pulsation, systolic flow murmur, tachycardia, flushed extremities?

Causes?

A

AV fistula

PDA, angioma, trauma, cancer, etc

357
Q

Pt that presents w/fever, fatigue, myalgia, arthralgia, dyspnea w/normocytic anemia and inc ESR has what?

358
Q

What causes alveolar Hypoventilation?

AA gradient is what?

PH status?

A

PE, atelectasis, Pleural effusion, Pulmonary edema all cause a V/Q mismatch

Elevated

Resp alkalosis

359
Q

What is the Path of Meneire’s?

A

Elevated endolymphatic pressure and volume d/t defective resorption of endolymph

361
Q

What meds lower uric acid levels?

What can increase risk of gout?

A

Loser tan, CCBs

Thiazides, loops, ASA, BB’s

362
Q

Pt that is in the post-MI period is most at risk for what?

A

Re-entrant ventricular arrhythmia (VFib)

363
Q

How do you treat aortic dissection?

A

Morphine
IV BB
Na Nitroprusside if SBP > 120

364
Q

Pt w/sudden onset paralysis and speech impairment has what?

What brain location?

A

Broca’s

Frontal lobe - inferior gyrus

BFIG

367
Q

What is the #1 change in vascular dementia?

What sx?

A

Executive functioning

Pronator drift

368
Q

Pt that has nosocomial UTI then gets IE, what bug?

A

Enterococcus

370
Q

Conn’s syndrome causes what to renin?

Aldosterone?

Bicarbonate? Why?

A

Low

High

High, hypoK causes increased renal bicarbonate resorption

371
Q

When does a ventricular septal rupture occur?

A

Hours - 1 week

372
Q

Liver problems w/elevated titers of ANA and ASMA is d/t what?

Treat how?

A

Autoimmune hepatitis

PO glucocorticoids

374
Q

When do you give IV bicarbonate in pt w/metabolic acidosis?

376
Q

Pt that has stent placement is likely to have a stent thrombosis if what?

A

Non-compliant w/their medication

377
Q

What is Charcot join? Complication of what?

Caused by what?

A

Neurogenic arthropathy
Neuropathy and repeated joint trauma

B12 def, DM, syphilis

378
Q

What causes back pain radiating to the foot?

A

Spinal nerve root entrapment

380
Q

MC causes of liver failure/infection < 1 month?

1-6 months?

> 6 months?

A

Bacterial

Opportunistic infxn - CMV, Aspergillus, Myco TB

Normal pathogens

381
Q

Mono can have what?

A

High false negative rate in the beginning of the illness (1st week)

382
Q

What does a Tc-99m test measure?

Also called what?

A

Perfusion of the heart

Single photon emission CT

383
Q

Adult Pt that has a chronic cough primary at night may have what?

384
Q

Bactrim causes what ion SE?

A

Hyperkalemia

385
Q

Pt that has chronic epigastric ABD pain that radiates to the back and gets better w/leaning forward has what?

A

Chronic pancreatitis

386
Q

Diabetes pt that has anorexia, N/V, early satiety and postprandial fullness has what?

Treat how?

A

Diabetic autonomic neuropathy of the GI tract

reglan or erythromycin

387
Q

Pt w/poorly controlled HTN, occipital HA, neck stiffness, N/V, and Ipsilateral hemiataxia of the trunk has what?

A

Right cerebellar hemisphere hemorrhage

389
Q

Pt that has severe agitation, combativeness, psychosis, delerium, myoclonus w/a prolonged duration lasting days has what?

A

Bath salts intoxication

390
Q

What is Ludwig angina?

A

Rapidly progressive cellulitis of the submandibular space, MC from dental infections

391
Q

CSF finds of Gillian Barre?

A

Inc protein

Everything else normal

392
Q

Pt that has VFib or pulseless VT, treat how?

A

Immediate defibrillator

394
Q

HIV pts can receive the varicella LIVE vaccine when?

395
Q

What is livedo reticularis?

A

Mottled reticulated vascular pattern that appears as lace-like purple discoloration of the skin

397
Q

What causes lid discomfort, CG inflammation of the meibomian gland, and is hard and painless lid nodule?

398
Q

Pt w/pancreatitis has what kind of blood flow?

This causes what?

Renin is?

Aldosterone?

A

Dec

Dec GFR

Inc

Inc

399
Q

What causes a single subcapsular cyst in the right hepatic lobe?

A

Amebic liver abscess

400
Q

What is the antidote for CN poisoning?

A

Sodium thiosulfate

401
Q

Uric acid stones are what?

Can bee seen how?

How to make soluble?

A

Radiolucent on Xray

US or CT

Potassium citrate —> 6-6.5 pH

404
Q

What is the MC cause of death in dialysis pts?

What %?

A

Cardiovascular disease

50%

408
Q

What is a complication of cardiac CATH that can manifest as blue toe syndrome, intestinal ischemia, AKI?

Treat how?

A

Atheroembolism (cholesterol embolism)

Supportive, statin

409
Q

What is the treatment algorithm in pt w/symptomatic bradycardia?

A

1st - atropine
Then IV Epi or dopamine
Or transcutaneous pacing

412
Q

SIADH will have what volume and sodium status?

A

Hyponatremia and euvolemia

419
Q

Pt w/spontaneous pain, odynophagia for hot and cold precipitated by stress that resolves w/nitrates and CCBs is what?

Dx how?

A

DES

Esophageal motility studies

421
Q

Controlling blood glucose below 6.5 A1c reduces what risk?

A

Diabetic retinopathy

Neuropathy

422
Q

Pt w/pyelonephritis and pmhx of CKD that suddenly develops Renal failure, what happened?

A

Amikacin SE

423
Q

What is the initial workup for essential HTN?

A

Lipid panel
Chem panel
UA
EKG

424
Q

MC complications of SAH?

Prophylax how?

A

Re-bleed in 24 hours
Vasospasm after 3 days

Nimodipine

426
Q

Pt that is 29 y/o w/elevated BP and EKG showing high voltage QRS w/downsloping ST-segment depression w/T-wave inversion in leads V5 and V6 w/symptoms of epistaxis, HA, LE claudication has what?

Dx how?

A

Coarctation of aorta

B/L arm and leg BP measurements

427
Q

What presents w/elevated TSH, normal T4 and T3?

A

Subclinical hypothyroidism

429
Q

What is Dacryocystitis?

Caused by what?

A

Inflammatory change in the medial canthal region of the eye

Staph aureus and strep

434
Q

Pt w/solid organ transplantation requires what to prevent organ rejection?

Dx how?

A

High dose immunosuppressive

Sputum w/special stain or BAL

436
Q

Pt w/intraocular foreign body is common in pts w/high-velocity injuries may have what negative exam?

Need to get what?

A

Pen-light exam

Fluorescein exam

437
Q

Pt w/sudden-onset odynophagia w/retrosternal pain that can cause difficulty swallowing?

D/t what?

EGD shows what?

A

Pill-induced esophagitis

Tetracyclines, NSAIDs, Bisphosphonates, KCl, Fe

Discrete ulcers

438
Q

MEN1?

A

Parathyroid
Pituitary
Pancreatic

440
Q

What is ichthyosis vulgaris?

Caused by what?

Treat?

A

Chronic, inherited skin disorder characterized by diffuse dermal scaling

Mutation in filaggrin

Emollient, keratolytics, topical retinoids

442
Q

What presents w/HA, N/V, ABD discomfort, confusion, coma and a pinkish-red skin hue?

Treat?

A

CO poisoning

Hyperbaric O2

446
Q

What kind of tumor affects young pts and makes AFP and hCG?

A

Nonseminomatous germ cell tumor

450
Q

What med causes SE of gingival hypertrophy, nephrotoxicity, hyperK, HTN, hirsuitism?

MOA?

A

Cyclosporine

inhibits transc. Of IL-2

454
Q

Tumor lysis syndrome causes what abnormal lab values?

A

HypoCa
HyperPO4
HyperK

455
Q

What causes recurrent painful oral aphthous ulcers and genital ulcers?

What other sx?

A

Behcet disease

Eye/skin lesions, thrombosis

457
Q

What presents w/loss of pain/temp in I/L face and c/L trunk and limbs w/dysarthria, dysphoria, hoarseness?

D/t what?

A

Wallenberg syndrome

Lateral medulla lesion

460
Q

What does a lesion of the lateral mid pons affect?

A

i/L trigeminal nerve, diminished jaw jerk reflex, muscles of mastication

462
Q

Loss-to-follow up in prospective studies is what type of bias?

464
Q

Mono lasts how long?

What other special feature?

A

Longer than 2 weeks

Generalized LAD

465
Q

Secretory diarrhea has what kind of osmotic gap?

Hallmarks?

A

Small, < 50

Large daily stool volumes, diarrhea that occurs during fasting and at night

466
Q

Diffuse CREST syndrome can cause what?

Leading to what?

A

Systemic sclerosis

ILD

472
Q

What pain med to give in cancer pt w/bony METS and Severe pain?

A

Short acting - morphine or hydro morphine

473
Q

What causes punctuate lesions w/surrounding erythema?

474
Q

Electrical alternans + Sinus tachycardia = ?

A

Pericarditis

478
Q

HepC pt w/palpable purpura, proteinuria, hematuria, glomerularnephritis and HM has what?

A

Mixed cryoglobulinemia

481
Q

What causes cauda equina syndrome?

What sx?

Treatment?

A

Compression of spinal n roots

LMN paralysis

IV steroids, emergency MRI

482
Q

Thalassemia is considered what?

A

Hemoglobinopathy

484
Q

Fibromyalgia CK level?

ESR?

Sx?

A

Normal

Normal

Widespread pain

485
Q

CMV retinitis described how?

A

Painless

Fundoscopy shows fluffy or glandular lesions

486
Q

What is a poor prognostic factor in systolic HF?

Why>

A

Hyponatremia w/CHF

Inc levels of renin, NE, ADH

492
Q

Serous OM is characterized how?

Common in whom?

A

Middle ear effusion w/out acute infection

AIDS pt

498
Q

Pt w/organ transplant w/pneumonitis, hepatitis, and gastroenteritis has what?

499
Q

What causes dactylitis?

What else can it cause?

A

Psoriatic arthritis

Nail pitting, onycholysis

504
Q

Mycophenolate SE?

MOA?

A

BM suppression

Reversible IMPDH inhibitor

509
Q

What causes significantly lower brachial systolic BP in 1 arm and a systolic bruit in the supraclavicular fossa w/S4 heart sound?

Dx how?

A

Subclavian steal syndrome

Doppler US w/MRA

515
Q

How does PCV13 PNA vaccine work?

A

Capsular polysaccharide conjugate to protein Ag

517
Q

Ascending aortic dissection can cause what abnormality?

518
Q

TCAs inhibit ______ in the His-Purkinje system and myocardium?

Affects the arrhythmiticity of the heart how?

If overdose treat how?

A

Fast Na channels

Dec conduction velocity, increases duration of repol, prolongs absolute refractory period

Sodium bicarbonate

521
Q

Treatment for toxoplasmosis encephalitis?

A

Sulfadiazine and pyrimethamine + Luecovorin

522
Q

Pleural effusion breath sounds?

Tactile fremitus?

Mediastinal shift?

A

Dec

Dec

Away from effusion

525
Q

Pt that receives solid organ transplantation needs what med?

To protect against what?

A

Bactrim

PCP, listeria, Toxo

527
Q

Wedge shaped infarct on CT means what?

Will see what on CXR?

A

PE

Hampton Hump

529
Q

PMHx of depression, dilated pupils, intestinal ileus w/QRS prolongation indicates what?

Tx?

A

TCA overdose

Sodium bicarbonate

536
Q

Exudate pleural fluid/serum ratio?

LDH?

pH?

Glucose?

A

> .5

> .6

7.3 - 7.45

< 60

538
Q

Painless, sudden, loss of vision in right eye in pt w/lots of RFs most likely has what?

A

Central retinal artery occlusion

540
Q

TPN as food can cause what symptoms?

Leads to what?

A

GB stasis, predisposes to gallstone formation and bile sludge get

Cholecystitis

542
Q

Kidney stones can cause what?

561
Q

Cardiac tamponade affects volumes of the heart how?

A

Dec LV preload

565
Q

Pt w/warlike lesions, violaceous nodules, skin ulcers w/acute PNA and osteomyelitis has what?

Treat?

A

Blastomycosis

Mod - PO itraconazole
Severe - IV Amph B

578
Q

Upper GI bleed that needs transfusion, give what?

A

Packed red blood cells

583
Q

Pt w/diabetes neuropathy but has hyperactive reflexes and Babinski sign means what?

Get what?

A

UMN problem

MRI spine

604
Q

Pt w/cirrhosis and portal HTN can develop what?

What pathology?

A

Hepatic hydrothorax, MC on the right

Fluid passage through diaphragmatic defects

617
Q

What is the PATH behind senile purpura?

Brown color d/t what?

A

Perivascular CT atrophy

Hemosiderin deposition

620
Q

Sick sinus syndrome path?

A

Sinuses pauses, can have inc PR or QRS interval

643
Q

Pt w/hypercalcemia, 24 hour hx of pain in swelling in knee has what?

Mc d/t what?

A

Pseudogout

Hyperparathyroidism w/chronic hypercalcemia

644
Q

Pt w/acute cocaine intoxication, treat how?

What is contraindicated?

A

IV benzo and oxygen

BBlockers

645
Q

Pts w/+ hepatojugular reflex have what etiology?

  • Hepatojugular reflex?
A

Peripheral edema d/t HF w/elevated JVP

Edema from primary hepatic disease and cirrhosis

646
Q

Exudative effusions are d/t what pathology?

A

Cytokines released during inflammation or infection INCREASE CAPILLARY PERMEABILITY

647
Q

How is central retinal artery occlusion treated?

A

Ocular massage and high flow O2

648
Q

What are the MC inciting factors of hepatorenal syndrome?

HRS occurs as what progresses?

Pts develop what?

A

SBP and GI bleed

Cirrhosis

Splanchnic arterial dilation and dec in vascular resistance

649
Q

What will causes pleural fluid to have a low pH and very high amylase (> 2500)?

A

Ruptured esophagus

UWorld Step 2 (17 decks)

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