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Uworld questions > MKSAP/Uworld > Flashcards

MKSAP/Uworld Flashcards

1
Q

How does brown sequard px?

A

contralateral loss of pain/temp ~2 levels of below lesion

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2
Q

What happens w/ Primary Biliary cirrhosis?

A

Get loss of biliary ducts

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3
Q

What is risk of NE presser?

A

alpha agonist properties can cause vasoconstriction which can lead to ischemia of distal extremities

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4
Q

What is major adverse rxn w/ INH?

A

can cause isoniazid hepatitis, d/c drug if ALT/AST >100

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5
Q

What is HCAP?

A

pneumonia acquired w/in 72 hours of hospitalization. Most often 2/2 G - rods (E. coli, P.A., Staph aureus)

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6
Q

Sx of CAP?

A

fvr, chills, cough w/ thick sputum, pleuritic chest pain, dyspnea, tachy, tachypnea, late insp crackles, bronchial breath sounds, pleural frxn rub

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7
Q

Common bugs w/ atypical CAP?

A

mycoplasma pneumo, Chlamydophila pneumonia, C. psittaci, coxiella burnetti, viral (influ A, B, adeno, parainflu, RSV)

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8
Q

Si/sx of atypical CAP?

A

HA, sore throat, fatigue, myalgia, dry cough, fvr, wheezing, rhonchi, crackles, Pulse-temp dissoc, nl HR in setting of fvr

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9
Q

How w/u suspected CAP?

A

cxr (PA, lateral), CBC, BMP, O2 sat, need cx before ABX, w/ G stam/ cx of sputum.

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10
Q

Waht bug causes CAP in certain popualtions?

A

Alcoholics - klebs, Immigrants - TB, nursing home - nosocomial esp upper lobes and pseudomonas

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11
Q

Who likely to get legionella?

A

organ xplant recipients, renal failure patients, chronic lung disease pts

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12
Q

What determines whether pt is hospitalized for CAP?

A

depends on severity of illeness, may tx some w/ outpatient ABx

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13
Q

How tx uncomplicated CAP if no comorbidities?

A

if uncompl tx w/ azithro or clarithro. If comorbidities px, add quinolones. COnt for >5 days or until afebrile for 48 hrs

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14
Q

How tx HAP?

A

tailored towards G- rods = cephalosporins, imipinem, zosyn

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15
Q

What is complication of penumonia?

A

can get pleural effusion if significant that requires drainage. Can progress to empyema.

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16
Q

Where are aspiration infxns most likely to occur?

A

Posterior seg of upper lobes and superior seg of lower lobes of R lung.

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17
Q

Why ventilator incrsd risk of pneumonia?

A

loss of clearance mechanism, positive pressure inhibits clearence

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18
Q

How tx VAP?

A

ceftazidime or cefepime, or zosyn + aminoglycosides or quinolones + vanc or linezolid

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19
Q

Organisms assoc w/ aspiration pneumo?

A

peptostrep, fusobacterium, bacteroides (oral flora), also S. aureus, S. pneumo, G- Bacilli

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20
Q

When does TB because clinical? Si/sx?

A

w/ secondary TB (primary TB usually asx), px w/ fvr, night sweats, weight loss, malaise, cough (dry to puruelnt) hemoptysis

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21
Q

What type of virus is flu?

A

orthomyxovirus, types A and B cause flu

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22
Q

How do bugs causing meningitis typicalyl spread?

A

invasion of blood and hematog seeding, Also retrograde xport along CN ( esp olfactory), can be contig spread from sinusitis, otitis media, surgery

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23
Q

When use cardiac resynchronization therapy?

A

CHF w/ EF< .12, w/ LBBB.

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24
Q

Common side effects of bisphosphonates?

A

can cause pill esophagitis, incrsd risk of fx if used for >5 years

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25
Q

How determine COPD?

A

do PFTs, if FEV1/FVC < 70 = COPD. FEV1 grades severity of COPd

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26
Q

What is delayed sleep phase syndrome?

A

Circadian rhythm sleep dx affecting time of sleep, px w/ falling asleep very late and having difficulty waking.

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27
Q

What is most common cause of acute pericarditis?

A

viral infxn

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28
Q

What are indications of hemodialysis?

A

refractory hyperK, volume overload/ refract pulmo edema, refract metabolic acidosis (pH<7,2), uremic pericarditis, uremic enceph/neuropathy, coagulopathy

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29
Q

When likely to get invasive aspergillosis?

A

immunocompromised pts esp neutropenia or on steroids

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30
Q

How invasive aspergillosis px?

A

fvr cough dyspnea, hemoptysis, cxr shows rapidly progressing, dense opacitiy, CT shows halo sign

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31
Q

Best way to lower BP from best to least?

A
  1. weight loss, 2. dash diet, 3. exercise 4. dietary sodium 5. ETOH decrsd
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32
Q

What is idopathic pulmo fibrosis?

A

restrictive lung disease of unknown cause, 2/2 chronic inflamm of alveolar walls = widespread fibrosis

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33
Q

PFTs in restrictive diseae?

A

dcrsd TLC, FEV1, FVC, nl-incrsd FEV1/FVC, get incrsd A-a gradient deu to perfusion mismatch

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34
Q

What is seen on cxr w/ IPF?

A

honeycomb pattern, dcrsd lung volumes, pulmo vascular congestion

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35
Q

SIde effect of loop diuretics and result?

A

can get hypoK and hypoMg can lead to arrythmias like vtach.

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36
Q

How does nocardia appear on gram stain?

A

crooked branching, beaded G+ partially acid fast filaments

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37
Q

How tx nocardiosis?

A

bactrim is tx of choice

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38
Q

What is relative risk?

A

measure of associ in cohort study, IF >1 then positive correlation, if less than one then negative associate. Greater the value, stronger the assoc

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39
Q

When use in ACEI in diabetics?

A

BP > target value or signs of diabetic nephropathy

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40
Q

How define diabetic nephropathy

A

spot urine albumin/ creatine >30

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41
Q

WHat is gemfibrozil?

A

fibrate that incrs HDL and dcrs TG

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42
Q

Si/sx of ethylene glycol poisoning

A

metab acidosis w/ anion gap, rectangular enveloped shaped crystals, can lead to ARDS, HF, renal failure

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43
Q

Si/sx of adrenal tuberculosis?

A

weight loss, fvr, sputum prodxn, nausea, ab pain, orthostatic hypotension, calcification of adrenals on CT

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44
Q

Findigns w. ATN?

A

BUN/Cr20, FENA>2%, muddy brown granular casts

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45
Q

What causes RBC casts? What does it indicate?

A

glomerular disease or vasculitis

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46
Q

Braod casts indicated what?

A

chronic renal failure

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47
Q

What drugs commonly cause acute pancreatitis?

A

diuretics, lasix, thiazides, IBD drugs, immunosuppressants, valproic acid, flagyl, tetracycline

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48
Q

How manage PVCs?

A

if asx, just observe, if sx then give beta blockers

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49
Q

What is most common adverse rxn w/ infusion in 1st 1-6 hrs?

A

nonhemolytic transfusion rxn

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50
Q

What causes a nonhemolytic xfusion rxn?

A

leukocytes in PRBCs release cytokines that when xfused lead to xsient fvr, chills, malaise w/ no hemolysis

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51
Q

When use irradiated blood?

A

BMT recipietns, acquired congenital immunodeficiencies, blood by 1st or 2nd degree relatives

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52
Q

How does acute hemolytic rxn w/ blood px?

A

Fvr chills, flank pain, hemoglobinuria, prevent w/ careful crossmatching/.

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53
Q

When screen for DM and how?

A

Begin at 45 if no risk fx, any screening test is appropriate

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54
Q

When do pneumococcal vaccination?

A

all patients >=65 y/o w/ revaccination 5 years after first dose.

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55
Q

What are skin tags associated w/?

A

insulin resistance, pregnancy, crohns.

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56
Q

What skin fx associated w/ hep C?

A

porphyria cutanea tarda, cutaneous leukocytosis, vasculitis (palpable purpura)

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57
Q

Si/sx of esophageal scleroderma?

A

sticking sensation in throat, dysphagia w/ heartburn, absence of peristaltic waves in lower 2/3 of esoph, dcrs LES tone

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58
Q

How differentiate esophageal scleroderma and achalasia?

A

incrsd in LE ton in achalasia, not dcrs

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59
Q

How does interstitial nephritis px?

A

fvr, rash, acute renal dysfxn, eosinophiluria, w/ WBC casts

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60
Q

How does bacillary angiomatosis px in HIV?

A

fvr, weight loss, ab pain, exophytic purple skin lesions, can get intrahepatic lesions, lesions are prone to hemorrhage, due to bartonella species.

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61
Q

Px of thyroiditis?

A

painless thyroid mass w/ hyperthyroidism, could be painful if de quervans. Low radioactive iodine uptake

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62
Q

When use two sample z test?

A

When comparing means

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63
Q

How manage diabetic pt w/ pyelo?

A

IV abx for 48-72 hrs, then switch to sensitive ABX PO for 10-14 days

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64
Q

What is abnormal PNH?

A

GP1 anchor protein which blocks CD55 & CD59 from binding - > leads to complement attachment and destrxn of RBC

65
Q

WHat are signs of intravascular hemolysis?

A

low hgb & low haptoglobin w/ incrsd bili and LDH

66
Q

RIsk w/ PNH?

A

predisposed to venous thrombi

67
Q

Most common causes of inflamm monoarthritis?

A

Septic arthritis & crystal induced arthritis. Incrs risk of septic arthritis if have RA.

68
Q

What is abnormal in parkinsons disease?

A

dopaminergic pathway damaged, unlimited activation of cholinergic pathway. Also loss of dopaminergic neurons in substantia nigra and locus cereleus

69
Q

Clinical fx of parkinsons?

A

pill-rolling tremor @ rest that is worse w/ emotional stress, bradykinesia, rigidity, poor postural reflexes, masked facies, micrographia, dementia in advanced disease.

70
Q

Cause of huntington’s chorea?

A

chr 4 mutation, AD, CAG repeats leads to loss of GABA producing neuron in striatum - > atrophy of head of caudate.

71
Q

How does cerebellar dysfxn present?

A

can occur w/ alcohol abuse, - > gait probs, truncal ataxia, nystagmus, intention tremor, dysmetria (tremor when trying to write), impaired rapid alternating movements.

72
Q

What is clasp knife spasticity?

A

represents clonus, suggests pyramidal tract disease

73
Q

Types of NF2 mutations?

A

Wishart - more severe, nonsense/frameshift mutation, no prodxn of tumor suppressor gene.
Gardner- milder missense mutat.

74
Q

Si/sx of beta thalassemia?

A

Meditern adult w/ microcytifc anemia, disproport RBC count, hypochromic & target cells. If Beta thal minor - > 1 abnml gene and 1 nml B gene

75
Q

What is purpose of hydroxyurea in sickle cell?

A

dcrs freq and severity of pain crises in pts w/ sickle cell

76
Q

Opthalmoscopic signs of amaurosis fugax?

A

retinal emobli lead to zones of whitened, swollen retina following distribution of renal arteries

77
Q

How does central retinal artery occluison appear?

A

Pallor of optic disc, cherry red fovea, boxcar segmentation of blood

78
Q

Most common cause of spontaneous bacterial peritonitis?

A

E. coli & kelbs - > tx w/ 3rd gen cephalo

79
Q

When does PCP occur in HIV? How dx?

A

CD4 counts <200, diagnose w/ BAL, sputum cx 50% sensitive

80
Q

Si/sx of TTP?

A

hemolytic anemia, renal failure, AMS, thrombocytopenia, low grd fvr, schistocytes on periph smear

81
Q

Si/sx of optic neuritis?

A

vision changes, color perception chng, pain in one eye, assoc w/ MS

82
Q

Cuase of infective endocarditis following dental caries?

A

Viridians group strep - > strep sanguins, s. mitis, s. oralis, s. mutans

83
Q

How dx parkinsonism?

A

dx w/ physical exam - > no lab/imaging

84
Q

How manage HIT?

A
  1. stop heparin 2. obtain serotonin release assay 3. Begin altern anticoag as high risk of thrombosis.
85
Q

What is manifestations of polyarteritis nodosa?

A

fvr, MS sx, vasculitis of nerves, GI tract probs, heart involvement, nonglomerular renal vessles. Get htn, kidney insuff, proteinuria, hematuria

86
Q

How dx PAN?

A

sural nerve biopsy + kidney angiography

87
Q

How tx giant cell arteritis?

A

Immediate high dose methylprednisolone.

88
Q

How tx Paget’s disease?

A

FIrst line is bisphosphonates, usually only tx symptomatic patients.

89
Q

What is screening and confirmatory test for HIV?

A

screening is ELISA, confirmatory is western blot

90
Q

How manage HIV pt w/ positive PPD?

A

even if cxr neg, need ppx tx w/ isoniazid x 9 mo. ALso tx w/ pyridoxine to prevent periph neuropathy.

91
Q

WHat is pathophys assoc w/ ARDS?

A

impaired gas exchange, dcrsd lung compliance, pulmonary htn. 2/2 lung injury 2/2 release of inflamm cytokines and neutrophils — leukage of fluid into alveolar space

92
Q

What is torticollis?

A

focal dystonia (involuntary cntrx) of SCM, can be twisting, reptitive movement, or sustained

93
Q

What is chalazion?

A

Painful swelling that progresses to rubbery nodular lesion on eyelid — chronic granulomatous condition — if persistent may be sebaceous carcinoma so should be biopsied.

94
Q

How does pericardial effusion appear on CXR?

A

heat enlarged w/ globular appearing shadow, “water bottle heart”

95
Q

How would cxr appear if audible 4th heart sound?

A

would get LV hypertrophy, (left lung space involved by heart)

96
Q

What is pulsus bisferrens?

A

biphasic systolic pulse felt w/ HOCM and AR

97
Q

WHat is AST:ALT ratio in ETOH liver disease?

A

AST:ALT > 2

98
Q

How does ETOH hepatitis px?

A

fvr, anorexia, hepatomegaly, jaundice, anorexia, incrsd LFTs, ggt, alk phos

99
Q

How can pericardial effusion initially px?

A

If slowly develop, minimum sx w/ enlrg cardiac silhouette, nml lung sounds, low volt ECG, no JVD

100
Q

Which gender more susceptible to ETOH hepatitis?

A

Females more susceptible

101
Q

Biopsy findings with ETOH liver damage?

A

Ballooning degen, Pmn infiltration, fibrosis, necrosis. May see Mallory bodies but these are non specific

102
Q

How does splenic abscess px?

A

Triad of fvr, Leukocytosis, LUQ pain, left side pleuritic chest pain and pleural effusion. May have splenomegaly.

103
Q

What bugs most often cause splenic abscess

A

Staph strep salmonella

104
Q

How splenic abscess likely to occur?

A

Can happen after infective endocarditis, sickle cell disease, HIV, IV drug use, or trauma

105
Q

How manage splenic abscess?

A

ABX, splenectomy, can do percutaneous drainage if not a surgery candidate

106
Q

How does cavernous sinus thrombosis px?

A

Inflamm at cs leads to thrombosis and intracranial htn, px w. Low grade fever, HA, periorbital edema, vomiting, papilledema. Bilateral CN deficits.

107
Q

How tx cavernous sinus thrombosis

A

Tx w. Broad spectrum ABX

108
Q

What type of cancer is Paget’s disease of the breast?

A

It is an adenocarcinoma

109
Q

How does Paget’s disease of breast appear on biopsy?

A

Large cells w. Halos due to cancer cells becoming retracted from adjacent keratinocytes

110
Q

Cortisol effects on BP?

A

Vasoconstrixn, insulin resistance leads to incrsd glucose, also mineralocorticoid activity

111
Q

Other findings in cushions disease

A

Proximal muscle weakness, central adiposity, thinning of skin, weight gain, psych problems

112
Q

Sx of pheochromocytoma

A

Weight loss, tachy, htn, diaphoresis, anxiety

113
Q

Organism causing infxn due to use of shared needles?

A

MRSA, staph, strept, also nml skin and oral flora

114
Q

Cause of infective endocarditis assoc w. UTI?

A

Most often due to enterococcus

115
Q

Anemia and lymphadenopathy think what?

A

Likely autoimmune hemolytic anemia 2/2 underlying malignancy — warm agglutination Ab, tx w/ prednisone

116
Q

How confirm multiple myeloma?

A

1st do serum electrophoresis looking for monoclonal m spike. Then do BM biopsy.

117
Q

How does cml px?

A

Fatigue, malaise, low grade fever, anorexia, weight loss, bone pain, fvr, night sweats, almost always over 50

118
Q

Complications of multiple myeloma?

A

HyperCa, hyperviscosity, renal failure

119
Q

Lab findings w/ CML?

A

Leukocytosis, anemia, incrsd number of mature granulocytes (segs and bands), bcr-abl, low leuk alk phosphatase

120
Q

How diff CML and leukemoid rxn?

A

W/ nml leukemoid rxn, leuk alk Phos is high

121
Q

How does cmv retinitis px? How tx?

A

Yellow white spots w/ retinal hemorrhages. Tx w/ ganciclovir and foscarnet

122
Q

How differentiate seminoma w/ nonseminoma germ cell tumor?

A

Seminoma only produces beta hcg and only 1/3 of time. Non seminoma produces beta hcg and AFP

123
Q

Possible tumors w/ nonseminoma gct?

A

Yolk sac carcinoma, choriocarcinoma, embryonal carcinoma mixed cell type

124
Q

How osteoclastic activity occur w/ diff tumors?

A

Breast cancer — metastases locally produce PTHrP

MM, leukemia — produce interleukins IL-6, RANKL that induce osteoclast activity

125
Q

Stand does a 4th heart sound indicate?

A

Cntrxn against stiff or hypertrophic ventricle. Occurs just before S1.

126
Q

What is Osler-weber-rendau syndrome?

A

Disease w/ hereditary telangiectasias, AD, px w/ recurrent epistaxis, widespread AV malformations

127
Q

In OWR. Where most likely to get AVM?

A

Mucous membranes, skin, GI tract, can have intrapulm shunt leading to hypoxia and polycythemia

128
Q

Most common cause of pneumonia in nursing homes?

A

Strept pneumo

129
Q

Px of CJD

A

Rapid progression of dementia, nystagmus, periodic high volt complexes on EEG

130
Q

What is seen on brain biopsy w/ CJD?

A

Cortical spongiform changes

131
Q

Lab findings w. Exogenous thyrotoxicosis?

A

Low tsh and hiigh free t4’ do thyroglobulin levels to confirm dx of exog thyroid hormone use

132
Q

What is thyroglobulin?

A

Precursor protein in thyroid follicle

133
Q

Major side effect of isoniazid?

A

Periph neuropathy due to B6 deficit. Prevent by supplementing with pyridoxine

134
Q

What is Jalisch herxheimer rxn?

A

Occurs w/ syphillis after tx. Due to spirochete dying and release of Ag, Ag-Ab complex form leading to immune rxn resembling acute syphillis

135
Q

Px of upper airway cough syndrome?

A

Cough following URI, mainly cough at night, no sputum prodxn

136
Q

How manage UACS?

A

Empirically tx w/ first gen oral antihistamine or decongestant+antihist combo

137
Q

What are possible products of homocysteine

A

Can become cysteine or methionine

138
Q

Stand cofactors needed to breakdown homocysteine

A

B6, folate, b12, most likely to be b6

139
Q

How does temporal arteritis px?

A

Elderly w/ new onset HA, jaw claudication, scalp pain, vision loss. On fundo see swollen pale disc w/ blurred margins

140
Q

How tx temporal arteritis?

A

High dose steroids

141
Q

MSG common cause of nephrotic syndrome in Hodgkin’s lymphoma

A

Minimal change most common but can also be FSGS

142
Q

What renal pathology assoc w/ visceral carcinomas

A

Membranous glomeruli nephritis

143
Q

Stand drugs improve mortality with MI?

A

Aspirin, beta blockers, ace inhibitors, heparin

144
Q

What drugs contraindicated in MI?

A

CCB (nifedipine)

145
Q

How tx pemphigous vulgarus?

A

Tx with prednisone 1st line, can also use azathiprine + metho with steroids

146
Q

How bullous phemphigous differ from PV?

A

Tense blisters in BP whereas flaccid in PV. BP rarely has oral lesions

147
Q

Px of erythema multiforme

A

Macular, popular, bullous, purpurin lesions w/ target lesions possible. Can form on extensor surfaces, palms, soles, mucous membranes

148
Q

If pt presents w. Limited history and diffuse depression of CNS how manage

A

Give thiamine, dextrose, o2, naloxone

149
Q

Signs of benzo OD?

A

Hypotension and drowsiness

150
Q

What vaccines contraindicated in HIV pt?

A

Bcg, anthrax, oral typhoid, intranasl flu, oral polio

151
Q

What live vaccines ok in HIV?

A

If >200 cd4, can give zoster, mmr, varicella

152
Q

Other notable vaccines needed in HIV.

A

Need Td every 10 yrs, pneumovax every 5 years

153
Q

What is greatest risk fx for variant angina?

A

Smoking

154
Q

What is riluzole?

A

Glutamate inhibitor used in ALS

155
Q

How does bronchiectasis px?

A

Cough w/ sputum prodxn most days, rhinosinusitis, dyspnea, hemoptysis, pleurisy, wheezing. Crackles clubbing

156
Q

Best test to dx bronchiectasis?

A

Do CT of chest

157
Q

CT findings with bronchiectasis

A

Bronchial dilation, lack of airway tapering, bronchial wall thickening

158
Q

How differentiate chronic bronchitis and bronchiectasis

A

Bronchiectasis px w/ lrg volhme of sputum prodxn (>100ml/day) also recurrent fvr, hemoptysis, P.A. Infxn

159
Q

How tx bronchiectasis?

A

Chest PT, ABX specific to CX

Uworld questions (13 decks)

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