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UWorld > Medicine 1 > Flashcards

Medicine 1 Flashcards

1
Q

What are some medications that may cause idiopathic intracranial hypertension (aka pseudomotir cerebri)? (2)

A

tetracyclines

hypervitaminosis A (retinoids)

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2
Q

A patient presents with dyspnea, orthopnea, paroxysmal nocturnal, and hemoptysis. She recently immigrated from Cambodia 2 years ago. She is diagosed with mitral valve stenosis. How does long-standing MS cause these symptoms?

A

Dyspnea - decreased blood flow to ventricle –> systemic circulation

orthopnea and PND - increased atrial pressure causes pulmonary vascular congestion –> pulmonary edema

hemoptysis - incrased atrial pressure causes polmonary vascular congestion –> polumoary edema and pushing RBC into fluid

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3
Q

What is tonometry?

A

procedure that determines intraocular pressure

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4
Q

A man reports something flew into his eye while using his hand-held drill. He claims he can feel something in his eye. After grossly examining his eye and not seeing anything, what would you do next?

A

fluoresceuin examination

allows for better visualization of globe

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5
Q

What happens when you increase the cutoff value? Decrease?

A

Think of true negatives as “specificity” and true positives as “sensitivity”. If the cutoff point increases, you increase the specificity. If the cutoff point decreases, you increase the sensitivity.

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6
Q

How are the different classes of asthma classified? How are they treated?

A

S. I. L. I. I. O

SABA, LDIC, LABA, IDIC, HDIC, O2

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7
Q

How does nitroglycerine relieve pain in cardiac patients?

A

Decreases ventricular preload resulting in decreased ventricular wall stress. This, after other downstream effects, causes a decrease in O2 demand therfore stopping pain.

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8
Q

What is normal ejection fraction?

A

55%+

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9
Q

What is a side effect of nitroprusside (commonly used for hypertensive emergencies)? What are common findings of this side effect?

A

cyanide accumulation/poisoning

Skin flushing (early) –> cyanosis (later)
altered mental status
tachypnea (early) –> repiratory depression (later)
Abdominal pain, nausea, vomiting

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10
Q

Why does warfarin increase hypercoagulability in the beginning of therapy?

A

Warfarin quickly decreases protein C concentratins within the first day while other procoagulant factor concentrations take days to decrease

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11
Q

What are the 3 types of renal tubular acidosis?

A
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12
Q

At what Hb concentration should someone recieve packed RBCs? Platelets?

A

Hb <7d/dL

<10,000/mm^3 OR 50,000/mm^3 if actively bleeding

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13
Q

Can acute BPH cause AKI?

A

Not generally. However, chronic obstruction from BPH can cause AKI

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14
Q

What should when a patient presents with acutely elevated creatinine?

A

renal ultrasound to assess for hydronephrosis and other causes of obstrutions

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15
Q

What causes subclavian steal syndrome?

A

stenosis or occlusion of the subclavian syndrome causing blood to be “stolen” from the vertebral artery

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16
Q

What is the distribution of mean, median, and mode for negatively skewed, normal distribution, positively skewed bell curves?

A
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17
Q

What causes the resting tremor in parkinson’s?

A

neuron degeneration in the basal ganglia (specifically the SN)

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18
Q

What are the clinical features of acute angle-closure glaucoma? What drugs can cause it?

A

acute HA, nausea, blurry vision, sluggish/dilated pupil with poor light response, corneal edema/cloudiness, conjunctival redness

drugs that dilate the pupil and cause closure (e.g. anti-cholinergics/antimuscarinics)

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19
Q

emphysema, chronic bronchitis, and asthma all show a decreased FEV1/FVC (<70%) and a decreased FEV1 (due to air trapping). How do they differ with DLCO?

A

Emphysema = decreased

Chronic bronchitis = normal

Asthma = increased

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20
Q

Define primary polydipsia, central DI, and nephrogenic DI. How will water deprivation affect urine osmolality? How will desmopressin affect urine osmolality in central and nephrogenic DI?

A

Primary polydipsia is commonly cause by psychiatric disorders where a patient is always drinking water. Urine osmolality will increase

Central DI is the inability to synthesize/secrete ADH. Urine osmolality will be low (dilute). Desmopressin will result in an increase in urine osmolality

Nephrogenic DI is when the kidneys do not respond to the presence of ADH. Urine osmolality will be low. Desmopressin will not have or will have a small effect on urine osmolality

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21
Q

How should patients with hypercalcemia be treated?

A

IV fluids to dilute the calcium

Calcitonin to help inhibit calcium resorptin via bones

bisphosphonate (delayed effect; 2-4 days later)

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22
Q

Name the three features of polyps that increase the risk of malignant progression

A

Villous features

size 1cm or greater

3 polyps of more

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23
Q

In patients with hypovolemia, what happens to renin secretion, efferent arteriolar resistance, and tubular resorption?

A

renin secretion increases (kidneys sense hypoperfusion)

increased efferent arteriolar resistance (increases GFR and BP)

increased tubular reabsorption (renin increases aldosterone which increases tubular reabsorption)

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24
Q

What are common causes of hypocalcemia associated with low PTH? Hypocalcemia associated with high PTH?

A

Most common cause of hypocalcemia with low PTH is surgery

Causes of hypocalcemia with high PTH is vitamin D deficiency and CKD which can be confirmed with serum 25-hydroxy vit D levels and renal function tests

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25
Q

What is a common bacterial opportunistic infection and viral opportunistic infection seen in immunocomprimised and immunosuppressed? What drugs should be added for protection?

A

penumocystis penumonia - TMP-SMX (Bactrim)

CMV - gancyclovir or valgancyclovir

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26
Q

What organism causes erysipelas?

A

streptococcus pyogenes (GAS)

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27
Q

How do you diagnose carpal tunnel?

A

nerve conduction studies

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28
Q

in a patient with a bradyarrhythmia, what would you give to speed it up?

A

antimuscarinic

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29
Q

if you suspect someone has avascular necrosis and Xray is normal, what should you order?

A

MRI

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30
Q

What is the treatment for a kidney stone 4mm or less?

A

adequate hydration (fluid intake >2L/day)

31
Q

In anaphylaxis, how should epinephrine be delivered? What if this route of delivery fails?

A

intramuscular epi. IV epinephrine is for those who fail to responde to intramuscular epi

32
Q

What are the signs/sx of CO poisening?

A

Pinkish-red skin hue, HA, nausea, vomiting, confusion, abdominal discomfort

33
Q

What is a bronchogenic cyst? Where are they typically found? Where are thymomas found?

A

congenital anomaly of the forgut that results in cyst formation which commonly present in the middle of the mediastinum

thymomas are found in the aterior fo the mediastinum

34
Q

What does the pronator drift test for?

A

upper motor neuron damage/lesion in the pyramidal tract

35
Q

A patient has meningococcal meningitis and requests to go home and be treated there. What should you do?

A

fuck that guy! He’s staying in the hospital cuz that shit is contagious

36
Q

When a patient has steatorhhea and also complains of bone pain, what would his PTH, phosphate, and calcium levels be?

A

steatorrhea means he has malabsorption of fat. Vitamins ADEK are fat soluble and would not be absorbed. The lack of vit D is what would cause the bone pain as Ca2+ is being drawn from broken down bone. Vitamin D is responsible for calcium absorption in the gut and in renal tubules.

High PTH, low phosphate, low calcium

37
Q

What lab test can identify nephropathy?

A

random protein/creatinine ratio

38
Q

What is the difference in PE findings between cellulitis and erysipelas?

A

cellulitis is deep and skin will be flat with poor demarcation

erysipelas is a superficial skin infection and will have raised skin with well demarcated edges

39
Q

What are CRAB symptoms in multiple myeloma?

A

hyperCalcemia

  • *R**enal involvement
  • *A**nemia
  • *Bone lytic lesions/B**ack pain
40
Q

What is sympathetic ophthalmia (aka spared eye injury)?

A

immune-mediated inflammation of one eye (the sympathetic eye) after a penetrating injury to the other eye.

Pathophysiological mechanism is believed to be the uncovering of ‘hidden’ antigens

41
Q

How does pyoderma gangrenosum evolve? What diseases is it associated with? How do you treat it?

A

starts as an inflammatory papule, pustule, or nodule and progresses to form an expanding ulcer with a purulent base and an irregular, violaceous border. Usually presents on the trunk or lower extremities.

associated with IBD, RA, and malignancy

treat with local or systemic glucocorticoids

42
Q

What is dacryocystitis? Which bugs typically cause it?

A

infection of the lacrimal sac (inner aspect of eye)

staph aureus and strep

43
Q

What are the manifestation os waldenstrom macroglobulinemia?

A

hyperviscocity syndrome (diplopia, tinnitus, HA, dilated/segmented fundoscopic findings causing vision problems)

neuropathy (electric sensation)

hepatosplenomagaly

anemia

thrombocytopenia

44
Q

How do you treat dermatitis herpetiformis?

A

oral dapsone and gluten free diet

45
Q

How do you treat bollous pemphigoid?

A

topical clobetasol (steroid)

46
Q

What causes hemi-neglect syndrome?

A

infarct of the non-dominant parietal lobe

47
Q

In osteomalacia, what would lab values look like for alkaline phosphatase, PTH, serum calcium, serum phosphorus, urinary calcium, and 25-OH-D?

A

Increased alkaline phosphatase

increased PTH

decreased or inappropriately low serum Ca2+

decreased serum phosphorus

decreased urinary calcium

decreased 25 OH-D

48
Q

How do you determine a transudative vs exudative effusion?

A
49
Q

Why does Zollinger-Ellison syndrome cause impaired fat absorption and diarrhea?

A

Zollinger-Ellison syndrome causes excess secretion of gastrin, which results in increased acid secretion. This increased acid production decreases the pH in the duodenum inactivating pancreatic enzymes leading to diarrhea and fat malabsorption

50
Q

What is pseudogout (crystal composition and cause)? What type of crystals?

A

pseudogout is caused by calcium pyrophosphate dihydrate (CPPD) and is a common complication of high serum calcium

rhomboid-shaped crystals

51
Q

What are common symptoms of meniere disease?

A

vertigo, sensorineural hearing loss, tinnitus

52
Q

in a craniopharyngioma, all pituitary hormones would be affected. Would aldosterone levels be lower as well?

A

no

the RAAS cycle initiated by the kidneys would maintain levels

53
Q

What are the distinguishing features between myasthenia gravis, lambert-eaton syndrome, and dermatomyositis/polymyositis?

A
54
Q

What is the emergency treatment for central retinal artery occlusion?

A

occular massage to try and dislodge the embolus to a point further dow the arterial circulation to improve retinal perfusion and high flow oxygen

55
Q

What is the treatment for a simple renal cyst?

A

reassurance

56
Q

What are clinical features of Behcet disease?

A

Recurrent, painful oral aphthous ulcers
Genital ulcers
Eye lesions (e.g. uveitis)
Skin lesions (erythema nodosum, acneiform lesions)
Thrombosis

57
Q

What is the mechanism of hydroxychloroquine? Adverse effect?

A

TNF and IL-1 suppression

retinopathy

58
Q

What is euthyroid sick syndrome?

A

classic is normal TSH and T4 and ELEVATED T3

59
Q

What type of imaging do you get to diagnose toxic megacolon?

A

abdominal Xray

barium enema is contraindicated as the bowel may be perforated and you don’t want to get the contrast into the abdominal cavity

60
Q

Can you give live vaccines to HIV patients with a CD4 count >200?

A

yes

Can’t if CD4 <200

61
Q

What is the preferred methd for HIV screening?

A

HIV p24 antigens and HIV antibodies

62
Q

What is the most common cause of spontaneous lobar hemorrhage, particularly in adults? children?

A

adults = cerebral amyloid angiopathy

Arteriovenous malformation

63
Q

What are symptoms of chronic arsenic toxicity?

A

sensorimotor neuropathy

skin lesions (hypo and hyperpigmented, hyperkeratotic)

pancytopenia

mild transaminitis

64
Q

What is the best treatment for metabolic alkalosis?

A

treat underlying cause

give notmal saline to correct

65
Q

in an individual with infective endocarditis who has NOT used IV drugs and has never had RF, what type of murmur would be present?

A

mitral regurgitation

(mitral stenosis in RF; tricuspid regurgistation with IVDU)

66
Q

how do you test for acromegaly?

A

1) test to see if IGF-1 levels are normal (secreted by liver)
2) if normal no worries - if abnormal do oral glucose suppression of GH
3) if adeqate supression no worries - if inadequate suppression do an MRI
3) if normal pituitary cause is extrapituitary - if pituitary mass surgery vs medical management

67
Q

does limited sodium intake help prevent calcium stones?

A

yes. decreased sodium intake will cause increased Na+/Ca2+ reabsorption

68
Q

How do you diagnose leprosy?

A

Biopsy lesion edge

69
Q

How does sodium bicarbonate treat TCA overdose?

A

sodium bicarb 1) increases pH which decreases the effectiveness of the TCA binding capacity to sodium channels and 2) increases serum sodium levels which increases the electrochemical gradient further affecting the ability of TCAs to bind to sodium channels

70
Q

What is the treatment for MS exacerbation? What if first line does not work?

A

glucocorticoids

plasmapheresis is done if patient does not respond to steroids

71
Q

What are the criteria for initiating long-term home oxygen therapy in COPD patients?

A

Resting PaO2 55mmHg or less
OR
resting SaO2 88% or less

72
Q

If a patient has hammer or claw toe deformity, what type of issue do they likely have?

A

diabetic peripheral neuropathy

73
Q

What is the treatment for carotid artery stenosis?

A

symptomatic patients recieve carotid endarterectomy (generally 70-99% stenosis)

asymptomstic patients recieve carotid endarterectomy with 80-99% stenosis OR antiplatelet and statin <80%

74
Q
A

UWorld (2 decks)

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