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Medicine UWorld Flashcards

1
Q 
what is dx in pt:
young - middle aged F
chronic WIDESPREAD PAIN
fatigue, impaired concentration
tenderness at trigger points (ex mid trapezius, costochondral junction)
A

Fibromyalgia

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2
Q

how do you dx fibromyalgia

A

> = 3 months of symptoms with widespread pain index or symptom severity score

NORMAL lab studies

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3
Q

what is dx in pt with:
proximal muscle WEAKNESS (difficulty climbing stairs); usually symmetric
pain is mild/absent

A

polymyositis

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4
Q

how do you dx polymyositis

A

ELEVATED MUSCLE ENZYMES (ex Creatinine kinase, Aldolase, AST)

autoantibodies (ANA, anti-Jo-1)

Biopsy: Endomysial infiltrate, patchy necrosis

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5
Q

what is dx in pt:
>50yo
systemic signs and symptoms
STIFFNESS > pain in shoulders, hip girdle, neck
associated with giant cell temporal arteritis

A

polymyalgia rheumatica

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6
Q

how do you dx polymyalgia rheumatica

A

ELEVATED ESR
ELEVATED C-REACTIVE PROTEIN

rapid improvement with glucocorticoids

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7
Q 
what is dx in pt with:
systemic symptoms
skin findings (lived reticularis, purport)
kidney disease
abdominal pain
muscle aches or weakness
A

polyarteritis nodosa

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8
Q

which lab value is usually elevated in polyarteritis nodosa

A

CRP

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9
Q

what is dx in pt with:
pain and swelling in wrists and small joints of hands
morning stiffness
systemic symptoms

A

rheumatoid arthritis

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10
Q

which lab value correlates with rheumatoid arthritis disease activity

A

CRP

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11
Q

what is dx in pt:
Male 15-35yo
elevated ESR and CRP
back pain that worsens with rest and improves with activity

A

seronegative spondyloarthropathies (eg ankylosing spondylitis)

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12
Q

describe selection of asthma treatments based on asthma severity x4

A

Intermittent:
SABA use <=2 days/week
Night <=2 times/month
Step 1 therapy

Mild persistent:
SABA > 2 days/week
Night 3-4 times/month
Step 2 therapy

Moderate persistent:
SABA use daily
Night >1 time/week but not nightly
Step 3 therapy

Severe persistent:
SABA use throughout the day
Night 4-7 times/week
Step 4 or 5 therapy

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13
Q

what are steps 1-6 in asthma therapy

A

Step 1:
SABA PRN

Step 2:
low-dose inhaled corticosteroid

Step 3:
low-dose inhaled corticosteroid + LABA
OR
medium-dose inhaled corticosteroid

Step 4:
medium-dose inhaled corticosteroid + LABA

Step 5:
High-dose inhaled corticosteroid + LABA
AND
consider Omalizumab for pts w/ allergies

Step 6:
High-dose inhaled corticosteroid + LABA + oral corticosteroid
AND
consider Omalizumab for pts w/ allergies

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14
Q

which asthma treatment has increased evidence of mortality when used as mono therapy, and how is that better managed

A

LABA mono therapy has evidence of increased mortality and treatment failure

the addition of LABA is indicated only in combination with an inhaled corticosteroid

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15
Q

if a short-acting beta-2 agonist (SABA) is not adequately controlling asthma symptoms, what is the next most likely addition to the pt’s treatment regimen

A

a daily controller medication, an inhaled corticosteroid in addition to the SABA

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16
Q

what is likely dx in immunocompromised pt with CT scan showing pulmonary nodules and surrounding ground-glass opacities (“halo sign”)

A

invasive aspergillosis

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17
Q

what is treatment for invasive aspergillosis

A

usually a combination of voriconazole and echinocandin (caspofungin)

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18
Q

what is dx in pt with no history of alcohol or gallstones presenting with acute pancreatitis, possibly with a recent vascular procedure

A

cholesterol emboli causing acute pancreatitis via vessel occlusion

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19
Q

what is dx in pt with skin, kidney, and GI manifestations of:
livedo reticularis (reticulated, mottled, discolored skin), blue toe syndrome
AKI
pancreatitis, mesenteric ischemia

A

cholesterol emboli

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20
Q

how do you manage acute pancreatitis from uncorrectable causes (ischemia, atheroembolism)

A

manage conservatively with analgesics and IV fluids

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21
Q

what is the dx in a pt with triad of nongonococcal urethritis, asymmetric oligoarthritis, and conjunctivitis

A

reactive arthritis

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22
Q

what are 2 common findings of reactive arthritis aside from its triad?

A

mucocutaneous lesions

enthesitis (Achilles tendon pain)

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23
Q

what does synovial fluid usually show in reactive arthritis

A

usually sterile

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24
Q

what is first line treatment for acute phase reactive arthritis

A

NSAIDs

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25
what additional symptoms other than the triad would you look for in a pt where you suspect gonococcal septic arthritis from reactive arthritis
fever lack of mouth ulcers and enthesitis (achilles) synovial fluid futures are negative in 50% of pts, so you can't always rely on that
26
what is dx in triad of polyarthralgias, tenosynovitis, and vesiculopustular skin lesions
disseminated gonococcal infection
27
what is dx in pt presenting <24 hrs after blunt thoracic trauma with: tachypnea, tachycardia, HYPOXIA RALES or decreased breath sounds normal pulmonary capillary wedge pressure CT or CXR showing patchy alveolar infiltrate NOT RESTRICTED BY ANATOMICAL BORDERS
pulmonary contusion | may not be clinically evident immediately
28
what is management of pulmonary contusion
pain control pulmonary hygiene (nebulizer treatment, chest PT) supplemental oxygen and ventilatory support (large doses of IV fluids may worsen pulmonary edema)
29
``` what is dx in pt with: blunt thoracic trauma hypotension, tachycardia, +/- arrhythmia +/- signs of heart failure abnormal pulmonary capillary wedge pressure ```
myocardial contusion | may be asymptomatic in most cases
30
how does acute pancreatitis cause ARDS
increased serum concentrations of pancreatic enzymes (ex phospholipase A2) can cross the pulmonary capillaries, damage lungs activate inflammatory cascade ultimately leads to: leakage of bloody and proteinaceous fluid into alveoli alveolar collapse 2/2 loss of surfactant diffuse alveolar damage
31
what is the best way to improve mortality in pts with ARDS on mechanical ventilation
low tidal volume ventilation (LTVV) this results in lower pulmonary pressures, which decreases the likelihood of over distending alveoli
32
what is the setting of a low tidal volume ventilation
LTVV = 6 mL/kg of ideal body weight
33
why are higher tidal volumes in ARDS harmful
may result in elevated pulmonary pressures due to work of forcing larger volumes into stiff lungs (decreased compliance), leading to increased alveolar distension
34
what is the oxygenation goal for mechanical ventilation in ARDS
SpO2 >88% (peripheral saturation) PaO2 55-80mmHg (arterial partial pressure)
35
which acid/base abnormality will potentially develop (but permissive and not associated with increased mortality) in pts on LTVV
LTVV strategies are associated with hypercapnia, and therefore respiratory acidosis
36
what drug usage commonly causes injury that mimics viral hepatitis
isoniazid
37
what is the most common composition of kidney stone
calcium oxalate
38
why might small bowel disease, surgical resection, or chronic diarrhea lead to formation of calcium oxalate stones
malabsorption of fatty acids and bile salts fat malabsorption leads to increased absorption of oxalic acid because the unabsorbed fatty acids chelate calcium, making oxalic acid free for absorption
39
which kidney stone is common in primary hyperparathyroidism and renal tubular acidosis
calcium phosphate
40
which kidney stone is common in increased cell turnover and dehydration
uric acid stones increased cell turnover causes hyperuricemia and hyperuricosuria
41
which kidney stone is common in alkaline urine from urease-producing bacterial infection
struvite stones
42
what is dx in pt with: elevated aminotransferases (often >1000) encephalopathy INR >= 1.5 (synthetic liver dysfunction)
acute liver failure
43
which drug is a common cause of acute liver failure, that may be potentiated by chronic alcohol use
acetaminophen
44
how does liver toxicity 2/2 acetaminophen overdose occur
toxicity results from overproduction of the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI), which leads to hepatic necrosis NAPQI is normally safely detoxified through glucuronidation in the liver, but this pathway becomes overwhelmed in overdose chronic alcohol use is thought to potentiate this toxicity by depleting glutathione lives and impairing glucuronidation process
45
what is an effective antidote for acetaminophen overdose, and what is its MOA
N-acetylcysteine it increases glutathione levels and binds to NAPQI, the toxic metabolite of acetaminophen (normally detoxified by glucuronidation in liver)
46
what are aminotransferase levels in cirrhosis
normal to moderately elevated aminotransferase levels
47
what causes right-to-left intrapulmonary shunting and an extreme V/Q mismatch, where hypoxemia does not correct increased concentrations of inspired oxygen
pneumonia
48
what is pathogenesis of pneumonia causing lung problems
in consolidative pneumonia, the alveoli become filled with inflammatory exudate marked impairment of alveolar ventilation in that portion of the lung results in R--> L intrapulmonary shunting, which describes perfusion of lung tissue in absence of alveolar ventilation (V/Q mismatch) unable to correct the hypoxemia even if you increase the concentration of inspired oxygen (FiO2) because V = 0
49
what does R--> L intrapulmonary shunting mean
perfusion of lung tissue in absence of alveolar ventilation | V/Q mismatch
50
diffuse alveolar hypoventilation can be caused from what 2 physiologic alterations
decrease in either tidal volume or respiratory rate
51
what is increased pulmonary capillary wedge pressure indicative of
increased LA pressure, | a sign of L heart failure
52
what is dx in pt with painful, visible tophi +/- chalky white drainage and a history of episodic mono arthritis in fingers and feet
tophaceous gout
53
what is pathognomonic for gout
uric acid tophi
54
what is dx in pt with deposition of calcium and phosphorus in skin presenting as scattered whitish papules, plaques, or nodules
calcinosis cutis
55
Which disease produces Heberden and Bouchard nodes
osteoarthritis
56
what is dx in pt with firm, flesh-colored, nontender nodules occurring over pressure points like the elbow and extensor surface of proximal ulna
rheumatoid nodules
57
what 3 broad categories encompass the signs of liver cirrhosis
portal hypertension hyperestrenism hepatic synthetic dysfunction
58
what signs are a result of portal hypertension in a cirrhotic pt
``` esophageal varices splenomegaly ascites caput medusae anorectal varices ```
59
what signs are a result of hyperestrenism in a cirrhotic pt
``` spider angiomata gynecomastia loss of sexual hair testicular atrophy palmar erythema ``` circulating estrogens affect vascular wall dilation
60
what signs are a result of hepatic synthetic dysfunction in a cirrhotic pt
ecchymosis edema decreased coagulation factor synthesis low protein synthesis = hypoalbuminemia hypoalbuminemia = decrease in intravascular oncotic pressure and fluid shifts to the extravascular space
61
what dx is the defective mineralization of the bone matrix
osteomalacia
62
what is osteomalacia commonly due to
severe vitamin D deficiency, which leads to decreased intestinal Ca and Phosphorus absorption, resulting in secondary hyperparathyroidism Ca and P are needed for mineralization the bone matrix
63
what is dx in pt with decreased bone density, thinning of cortex, and pseudo fractures (Looser zones)
osteomalacia
64
what is dx in pt with accelerated focal bone remodeling
Paget's disease of bone
65
what is pathogenesis of Paget's disease of bone
first, increased osteoclastic activity | then rapid and disorganized new bone formation by osteoblasts
66
what are lab values in Paget's disease of bone
normal serum Ca, P, and PTH markers of bone resorption (C-telopeptide, n-telopeptide) and bone formation (Alk phos, osteocalcin) are significantly elevated
67
what is dx in pt with defective type 1 collagen formation
osteogenesis imperfecta
68
what is dx in pt with low bone mass but adequate bone mineralization
osteoporosis
69
what are lab values in osteoporosis
normal serum Ca, P, PTH, and Alk Phos
70
what is dx in pt with lytic bone lesions
activation of osteoclasts, from solid tumors (breast, renal cell) or multiple myeloma
71
what is ESR a marker for
inflammation
72
what is initial evaluation step in pt with h/o difficulty initiating swallowing with cough, choking, or nasal regurgitation
pt likely has oropharyngeal dysphagia, | so first step is video fluoroscopic modified barium swallow test
73
what presents as dysphagia with solids and liquids at onset
motility disorder
74
what presents as dysphagia with solids progressing to liquids
mechanic obstruction

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