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Random UWorld Flashcards

1
Q

treat HYPERNatremia

euvolemic
hypovolemic asymptomatic
hypovolemic symptomatic

how and why to limit rate of serum sodium correction

A

euvolemic - free water

hypovolemic asymptomatic - D5 (hypotonic)

hypovolemic symptomatic - .9% NS (isotonic) till euvolemic, then D5 (hypotonic)

Limit Na correction to .5mEq/dl/hr (12mEq/dl/24hr) – or Risk CEREBRAL EDEMA

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2
Q

mechanism of Li induced nephrogenic diabetes inspidus

symptoms

treatment

A

ADH Resistence by Impairing Water Resorption in collecting duct

nocturia, polyuria, polydipsia, CNS symptoms when severe

discontinue lithium, if cannot - salt restriction and amiloride (select diuretic)

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3
Q

water deprivation test differentiates between…

A

central diabetes insipidus (low ADH from pituitary)

nephrogenic diabetes insipidus (ADH resistance in kidney - impaired water resorption)

primary polydipsia

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4
Q

Manage hypercalcemia

severe
moderate
mild

A

^14 or symptomatic - IVNS and Calcitonin acutely, Bisphosphonate long term (Zoledronic Acid, Pamidronate)

12-14 - only treat as above if symptomatic

v12 asymptomatic - no immediate treatment…. avoid thiazide diuretics (can use loop diuretics to secret calcium Only if volume up) avoid lithium, volume depletion, prolongued bed rest

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5
Q

why might an old lung cancer guy with PTHrp secreting tumor get an AKI

A

volume depleted via hypercalcemia-induced nephrogenic diabetes (trying to pee out the calcium)

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6
Q

why will fiail chest patient have decreased lung sounds in bases bilaterally

A

shallow breaths to avoid pain

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7
Q

treat flail chest

A

pain control
supplemental O2

if respiratory failure eg from edema/blood/pulmonary contusion - PPV Positive Pressure Ventilation… maybe with prophylactic chest tube to minimize risk of mechanical PPV causing tension pneumo

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8
Q

how to follow an AAA

A

ultrasound is all that is needed, very sn and sp and can measure and see thrombi

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9
Q

TF

abruptio placenta can cause extreme maternal pain

A

T

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10
Q

at 36 weeks gestarion, sudden extreme pain, vaginal bleeding, firm distended uterus, low fetal heart rate

diagnosis

A

abruptio placenta

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11
Q

Pain?

placenta previa vs abruptio placenta

A

no pain placenta previa usually, just painless bleeding

PAIN Abruptio Placenta, severe

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12
Q 
interstitial cystitis
aka
assoc with
UA findings
treatment
A

aka painful bladder syndrome

assoc with anxiety, fibromyalgia, psche and pain syndromes

UA normal

treat with Behavioral Modification and Trigger Avoidance, Amitripyline, Analgesics for exacerbations

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13
Q

Criteria for home oxygen

general

if right heart failure or polycythemia?

A

generally if SpO2v88% or PaO2v55mmhg

if RHF or PCV (HC^55%) then SaO2v89% PaO2v59mmhg

(supplement to SpO2^90%)

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14
Q

what kind of diuretic can treat calcium kidney stones

A

thiazide diuretic
-hypercalcemia, hypocalcuria

(all others, loops, potassium sparing, increase urinary calcium excretion)

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15
Q

longstanding smoking and chronic productive cough with recent hemoptysis

chronic cough with daily production of copious mucopurulent sputum in setting of recurrent respiratory tract infections

diagnoses?

A

Chronic Bronchitis - smoking, chronic small productive cough with recent hemoptysis

Bronchiectasis - irreversible dilation and destruction of bronchi, chronic cough and impaired mucus clearance, history of recurrent URIs and copious mucupurulent sputum… can also cause hemoptysis

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16
Q

3 most common causes of hemoptysis in adults

A

pulmonary airway disease

  • chronic bronchitis
  • bronchogenic carcinoma
  • bronchiectasis
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17
Q

define chronic bronchitis

most common cause

A

Chronic Productive Cough ^3months in 2 successive years

smoking most common cause

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18
Q

how can ruptured AAA cause hematuria

A

can rupture into retroperitoneum, cause aorto-caval fistula (aorta-IVC) backup of venous system, bleeding of bladder veios, hematuria

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19
Q

potential ECG changes with ruptured AAA

A

ischemic changes

eg ST Depressions

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20
Q

TF

Drug Fever is a common cause of fever 1-2 hours postop

A

F
Drug Fever 1-2 WEEKS postop – more allergic picture with rash and eosinophilia

1-2 hour postop fever ddx is

  • preop infection or trauma
  • malignant hyperthermia
  • medications side effect (eg to anesthesia… but this is NOT “Drug Fever”
  • Febrile NonHemolytic Transfusion Reaction to Blood Products
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21
Q

Febrile NonHemolytic Transfusion Reaction

time to onset
cause
treat

A

1-6 Hours after transfusion

cytokine buildup in stored blood by residual leukocyte debris

stop transfusion, rule out other serious causes of fever (acute hemolytic ABO incompatability), antipyretics (avoid aspirin if thrombocytopenic)

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22
Q

appendicitis symptoms ^5 days with phlegmon with abscess that has walled off

manage

A

manage conservatively with abx and bowel rest, then Delayed Appendectomy weeks later

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23
Q

trauma to sphenoid bone will classically cause… epidural or subdural hematoma? how?

A

sphenoid trauma - Epidural Hematoma - tearing of Middle Meningeal Artery

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24
Q

sphenoid trauma, bruise, ipsilateral pupillary dilation

diagnosis?
mechanism of pupillary dilation?
how to treat when focal neurological deficits?

A

epidural hematoma

increased intracranial pressure
uncal herniation - CN III Palsy and Hemiparesis

if FNDs treat with Craniotomy to decrease ICP

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25
Q

brief unconsciousness, lucid interval, then worsening state again… what kind of dural hematoma

A

epidural hematoma

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26
Q

most common location of urethral injury with pelvic fracture, why

next step if suspected

what to do with urine leading up to urethral repair

A

Posterior Membranous urethra at bulbomembranous Junction (between prostate and penis) – where less support and risk for tearing when bladder and prostate elevated in pelvic fracture

get Retrograde Urethrogram

temporary Suprapubic Catheter while awaiting Delayed repair when associated with pelvic fracture… don’t foley because may damage urethra more, don’t repair immediately unless anterior urethra without pelvic fracture… because must address pelvic fracture first…

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27
Q

acanthosis nigracans (thick velvety skin plaques) in PCOS indicates

A

insulin resistance (diabetes)

suggested by acanthosis nigracans thick velvety skin plaques

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28
Q

how does clomiphene citrate induce ovulation

A

Selectively Blocks Estrogen Receptors in Hypothalamus to Restore Pulsatile GnRH, normalize LH and FSH and LH SURGE

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29
Q

how could bromocriptine induce ovulation

A

Dopamine Agonist blocks HyperPROLACTINEMIA which was preventing ovulation

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30
Q

what is Cyclic Progesterone supplementation’s role in the the treatment of PCOS

A

endometrial protection from uncontrolled anovulatory estrogen fueled proliferation

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31
Q

when are pregnant women screened for diabetes

and how, fasting glucose?

A

screen at 24-28 Weeks for Gestational Diabetes

Earlier IF HIGH RISK

screen with 1 Hour OGTT, more sensitive than fasting blood glucose

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32
Q

TF

if pregnant woman not flu-vaccinated, and it is flu season, the next best step is always Vaccinate with Inactive Virus

A

TRUE

Vaccinate in ANY TRIMESTER and IF BREAST FEEDING, NO CONTRAINDICATION to INACTIVE virus

…active vaccine contraindicated in pregnancy

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33
Q

44yo F with night sweats, insomina, irregular periods 6 mos, otherwise healthy – no thyroid abnormality on exam

top 2 ddx?
next steps

A

still HyperThyrodism and Menopausal transition even with normal thyroid exam, a little early for Menopausal transition (usually ^45yo) but not very early…

so think TSH and FSH next… must rule out thyroid issue before concluding menopausal

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34
Q

pale enlarged turbinates, transverse nasal crease, and pharyngeal cobblestoning are suggestive of ___

treat with ___
less effective alternatives include…

A

pale enlarged turbinates, transverse nasal crease, and pharyngeal cobblestoning suggest ALLERGIC RHINITIS

treat with INTRANASAL CORTICOSTEROID

less effective alternatives include nonsedating oral antihistamines, cromolyn nasal sprays, leukotriene modifiers

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35
Q

TF

intranasal glucoccorticoids for allergic rhinitis cause rebound congestion (rhinitis medicamentosa)

A

FALSE

that’s nasal decongestant sprays (alpha antagonists?) that cause rebound congestion rhinitis medicamentosa

intranasal glucoccorticoids are first line for allergic rhinitis

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36
Q 
genitopelvic pain / penetration disorder
aka
risks
features, key absent feature
treatment
A

aka vaginismus

risks - past trauma, abuse, lack of sexual knowledge

features - pain and anxiety re Penetration (not external genital tenderness) with no medical cause

treat - desensitization therapy, kegels

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37
Q

vulvodynia and pudendal neuralgia will produce pain/tenderness where

A

superficial vulva / external genitalia

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38
Q

watch out especially for concurrent use of these two drug classes when prescribing sildenafil

A

nitrates, alpha blockers

risk combined hypotension

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39
Q

manage suspected PE in 3 steps

A

1 - O2, IVMF
2 - assess for Contraindication to Anticoagulation - if CI, diagnostic testing

3 - if No CI, assess PE probability with Modified Wells Criteria

  • 3points if DVT or PE most likely dx
  • 1.5points if prior DVTPE, HR^100, or recent Surgery or Immobilization
  • 1point if Hemoptysis or Cancer
  • –^4 PE likely (and in distress), anticoagulate
  • –v4 PE unlikely, get diangostic testing

Basically, if PE most likely and patient in distress and no CI, skip diagnostics and anticoagulate… because huge in reducing mortality

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40
Q

postop CABG guy intubated in SICU with fever WBC RUQ tenderness… most likely dx?

even with no jaundice and normal LFTs?

diagnose
treat

A

ACALCULOUS CHOLECYSTITIS (F WBC RUQ pain with risk factors… yes jaundice and lft abnorms are less common… if Alk Phos elevated think more Cholangitis)

risk factors are severe trauma or recent surgery, critical ICU illness, prolonged fasting or TPN

RUQ US…. HIDA or CT if needed

antibiotics, cholecystostomy till clinically stable for cholecystectomy

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41
Q

Acute Acalculous Cholecystitis is acute inflammation of the gallbladder in the absense of gallstones most commonly seen in

A

acute acalculous cholecystitis most commonly seen in Hospitalize and Critically ill Patients

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42
Q

MVA guy with blow to lower abdomen and pelvis with chemical peritonitis… what part of GU system probably injured? Why? Mechanism?

A

Dome of bladder
adjacent to peritoneal cavity

sudden blow and increase in bladder pressure while full can cause rupture upward into peritoneal cavity and chemical peritonitis… lower pelvic bladder injuries urethral injuries and retroperitoneal structures etc not going to cause intraperitoneal leaks and peritonitis… more lower abdominal pain or back/flank pain

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43
Q

1st and 2nd line therapy for BPH

A 
alpha blockers (terazosin, tamsulosin)
-1st line, fast onset, rapid relaxation of bladder neck and prostate smooth muscle

5-alpha reductase inhibitors (finasteride)
-2nd line, delayed effect,… take months to shrink prostate

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44
Q

normal post void residual in nonoperative patient

A

v12ml

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45
Q

TF

low PSA means less suspicion for BPH

A

Fish not really

PSA suggests prostate cancer… also BPH a little bit… but less…

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46
Q

when to get Urodynamic studies in general

when to get in setting of BPH

A

urodynamics to assess for Overactive Bladder, Neurogenic Bladder

get in BPH if FAILED Medical treatment or Atypically present v50yo

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47
Q

15yo 2 years post-manarche with irregular cycles, family history of PCOS but she has no ovarian cysts no hirsutism no obesity etc… positive bleed with progesterone challenge…

cause of irregular menstrual cycles probably PCOS or or just developing HPA axis? cause of each? Typical time to HPA normalization in newly menstruating female?

A

prob HPA immaturity (low GnRH secretion… so estrogen but not regular ovulation or progesterone so uterine buildup and positive bleed with progesterone challenge)…. can take 1-4 YEARS TO NORMALIZE

anovulation in pcos from elevated androgens and LH… without other signs hpa immaturity is more likely

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48
Q

first 5 steps for suspected variceal hemorrhage in cirrhotic with hematemesis

f/u management

A

2 large bore IV catheters

Fluids
IV Octreotide
Abx

Endoscopic eval/therapy Urgently

f/u BB, band ligation, TIPS depending on control

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49
Q

megacolon/megaesophagus with cardiac disease in Latin American think…

A

CHAGAS disase
chronic protozoal disease cause by
TRYPANOSOMA CRUZI

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50
Q

2 primary manifestations of Chagas disease

demographic
bug

pathophys

A

Megacolon/Megaesophagus
Cardiac disease

Latin America
Trypanosoma Cruzi

destruction of Nerves to GI smooth muscle
Myocarditis from protozoal infection

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51
Q

general Diptheria symptoms

A

Upper Respiratory Tract symptoms with Diptheria

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52
Q

treat frostbite

A

rapid rewarming with Warm Water ~body temp

analgesia and wound care

Thrombolysis if severe/limb-threatening/amputation probable
(not for limited distal frostbite)

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53
Q

when is debridement indicated for frostbite

A

after rewarming and accurate survey of devitalized structures

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54
Q

for what diagnosis are CCBs nifedipine amlodipine indicated for cold fingers

A

Raynaud’s

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55
Q

most common causes of Cirrhosis in the USA

A

viral Hepatitis B more than C
Alcoholism
NAFLD
Hemochromatosis

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56
Q

what are you looking for in family history of cirrhotic

A

hemochromatosis (bronze diabetes, cardiomyopathy, arthropathy)

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57
Q

pt with heart failure diagnosed 2 mos ago and treatment started now has chronic dry cough 1 month but no signs of heart failure, seems well controlled… likely cause of cough?

A

ACEI - angioedema, cough
prob started as 1st line for CHF
produces cough in 20% of patients

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58
Q

what CHF drug class should always be considered on the differential for chronic cough?

A

ACEI

bradykinin, agioedema, cough

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59
Q

old guy gross hematuria or microscopic hematuria with cancer risks with no evidence of glomerular disease or infection… next step

A

cystoscopy

bladder cancer… think when painless hematuria

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60
Q

TF

BPH can cause hematuria

A

T
BPH can cause hematuria
but must rule out bladder cancer before settle on BPH

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61
Q

management of inevitable abortion depends on __ and __

options include __ __ and __

A

patient preference and vital stability

options- Expectant, Misoprostol induction, Suction Curettage (indicated above others if infection or hemodynamic instability)

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62
Q

TF

Oxyctocin for medical abortion

A

F
few oxytocin receptors in fist/second trimesters

Misoprostol for medical abortion

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63
Q

hallmark LFTs of Ischemic Hepatic Injury (Shock Liver)

timecourse of abnormalities

A

Massively Elevated AST ALT
modest tbili and alk phos

spike within a day of insult
1-2 weeks to recovery after treated

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64
Q

TF

prostate cancer commonly mets to liver

A

FALSE
prostate mets to Pelvic Lymph Nodes and Bones

To Liver: Colon Cancer #1, also Lung and Breast

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65
Q

most common mets to liver

A

Colon #1

Lung and Breast

66
Q

Mets to liver on CT

next diagnostic test

A

Colonoscopy

most common Mets to Liver: Colon #1, Lung and Breast

67
Q

old guy with mets to liver, slightly enlarged prostate, most probable source of mets? Next test?

A

Colon Cancer #1 Mets to Liver
also Lung and Breast
get COLONOSCOPY

Prostate mets to Pelvic Lymph Nodes and Bones not liver

68
Q

how does NSAID cause AKI

A

constricts afferent arteriole

69
Q

cause of AKI in HepatoRenal Syndrome

treat

does it improve with volume resuscitation?

A

Cirrhosis, Portal HTN, SBP and GI Bleeding, SPLANCHNIC ARTERIAL DILATION and DECREASE IN OVERALL VASCULAR RESISTANCE….. RAAS Activation, Renal Vasoconstriction

treat - recover hepatic function by ABSTAINING from Alcohol, or TRANSPLANT… temporize to transplant with splanchnic vasoconstrictors - Midodrine, Octreotide, Norepiniephrine… Albumin…. maybe Dialysis

does not improve with volume resuscitation… not from hypovolemia

70
Q

3 most common causes of ATN

and UA findings

A

Aminoglycosides
Iodinated Contrast Dye
Hypotension

Muddy Brown Granular Casts on UA

71
Q

HepatoRenal Syndrome

does it improve with volume resuscitation?

why/why not?

A

No, HRS does not improve with volume resuscitation

because not due to hypovolemia… due to Splanchnic Arterial Dilation and Decrease in Overall Vascular Resistance

(Cirrhosis, Portal HTN, SBP and GI Bleeding, SPLANCHNIC ARTERIAL DILATION and DECREASE IN OVERALL VASCULAR RESISTANCE….. RAAS Activation, Renal Vasoconstriction)

72
Q

2 causes of AIN

and UA findings

A

Infection and some Antibiotics both cause AIN

White Cells and White Cell Casts on UA

73
Q

causes of ATN vs AIN an UA differences

A

ATN - Aminoglycosides, Iodinated Contrast Dye, Hypotension…Muddy Brown Casts

AIN - Infections and certain Antibiotics… WBCs and WBC Casts

74
Q

hearing loss with dull hypomobile tympanic membrane in AIDS patient

diagnosis
pathophys

A

Serous Otitis Media

HIV LYMPHADENOPATHY or OBSTRUCTING Lymphoma leads to NON-INFECTIOUS Middle Ear Effusion

75
Q

___ is a demyelinating disease that can occur in patients with HIV/AIDS with CD4 count v___

A

PML Progressive Multifocal Leukoencephalopathy

is a demyelinating disease that can occur in HIV/AIDS pts with CD4 count v200

76
Q

when to bronch a chronic cough

A

RARELY

only if foreign body suspected really

77
Q

TF
asthma may present with chronic cough that is predominantly nocturnal

how does this knowledge inform your workup

A 
T
so if already failed a 1st gen H1 blocker (not upper airway cough syndrome / postnasal drip,
already on a PPI (not GERD)
not on an ACEI
low suspicion of infection or cancer

consider PFTs

78
Q

2, TWO major toxic products of combustion (fire) in closed spaces

treat one empirically
why

do they cause methemoglobinemia?

A

Cyanide - combustion of foam cotton paint silk Nitrogen Containing Polymers

  • HydroxoCobalamin or Sodium ThioSulfate Antidotes (bind cyanide)
  • Nitrites to Induce Methemoglobinemia (Fe3 which binds cyanide) IF NO ANTIDOTE AVAILABLE
  • Respiratory support, Fluid support
  • —treat to avoid eg CARDIORESPIRATORY ARREST and PERMANENT NEUROLOGIC DISABILITY, no way to measure exposure so treat empirically

CO Carbon Monoxide #2

-Methemoglobinemia (oxidation of ferrous Fe2 to Ferric Fe3 in Hb which cannot bind oxygen causing a functional anemia) occurs after exposure to Oxidizing agents DAPSONE NITRATES topical/local ANESTHETICS…. NOT FIRE, NOT CO POISONING… that is carboxyhemoglobin… i think…

79
Q

how does Cyanid toxicity, e.g. inhaled in house fire /combustion of nitrogen containing household polymers, cause Lactic Acidosis?

A

Cyanide Reduces Oxygen Utilization by Tissues

inhibits cytochrome oxidase a3 in mitochondrial electron transport chain by binding Ferric Fe3 preventing reduction to Ferrous Fe2 so NO ATP from Oxydative Phosphorylation so ANAEROBIC METABOLISM and LACTIC ACIDOSIS

80
Q

TF

unilateral pleural effusion rules out CHF as the cause

A

F

usually bilateral in CHF but 10-30% unilateral

81
Q

pH of

normal pleural fluid
transudative pleural effusion
exudative pleural effusion

A

normal - 7.6 (higher than serum)
transudate - 7.4-7.55 (serum plus)
exudate - 7.30-7.45 (serum minus)

82
Q

what to think of high amylase in pleural fluid

A

think pancreatitis-associated effusion or esophageal rupture (saliva)

83
Q

sympathetic ophthalmia
aka
is characterized by

A

aka “spared eye injury”

characterized by immune recognition (antibody or cell-mediated) of “hidden” antigens in one eye (the sympathetic eye) after a penetrating injury to the other eye

84
Q

inflammation and breast inflammation/dimpling/pitting without fever is trying to point you to

A

peau d’orange INFLAMMATORY BREAST CANCER

(DIMPLING NOT typically seen with MASTITIS or INFECTION… THINK CANCER… ABSENCE OF FEVER should also make you think LESS MASTITIS/INFECTION and MORE CANCER)

workup is mammography, ultrasound, tissue biopsy

85
Q

morbidly obese woman stopped breast feeding 2 mos ago now with 1 month of unilateral breast pain and inflamed dimpling/pitting no fever…

top diagnosis is
workup is

A

peau d’orange INFLAMMATORY BREAST CANCER

(DIMPLING NOT typically seen with MASTITIS or INFECTION… THINK CANCER… ABSENCE OF FEVER should also make you think LESS MASTITIS/INFECTION and MORE CANCER)

workup is mammography, ultrasound, tissue biopsy

86
Q

what helps you differentiate between Mastitis, Infection, and Inflammatory Breast Cancer on patient presentation with painful breast

A

Mastitis/Infection - fever

Inflammatory Breast Cancer - peau d’orange dimpling/pitting

87
Q

___ is a benign palpable breast mass most commonly found in young women – estrogen-sensitive tumor typically firm and mobile with regular borders and spherical shape

A

Fibroadenoma

is a benign palpable breast mass most commonly found in young women – estrogen-sensitive tumor typically firm and mobile with regular borders and spherical shape

88
Q

___ is a benign condition that typically presents with unilateral bloody nipple discharge and no other symptoms or skin changes

A

Intraductal Papilloma

is a benign condition that typically presents with unilateral bloody nipple discharge and no other symptoms or skin changes

89
Q

treat laryngeal edema from food allergy eg sob in restaurant

A

epinephrine
systemic corticosteroids
antihistamines

90
Q

empty gestational sac with yolk sac but no fetal pole and b-hCG 25,000 dropped to 24,000 with no change to ultrasound suggests…

missed abortion or molar pregnancy?

A

missed abortion - sac no fetus or fetus no heart rate with closed cervix, declining b-hCG

mole would be snowstorm appearance and b-hCG SUPER high like 100,000

91
Q

adult single toxic dose of acetaminophen
peds toxic dose

first step in management

A

7.5g adult, 150mg peds
Activated Charcoal if v4 hours since ingestion,
measure Acetaminophen level

92
Q

^3 mos fever weight loss fatigue cough hemoptysis or dyspnea

cavitary lung lesion with debris/fluid on CT with history of cavitary TB

think
pathophys
diagnose
treat

A

chronic pulmonary aspergillosis

aspergillus many of us are exposed to every day can get traction in underlying lung disease / prior cavitary TB especially or immunocompromise

diagnose with aspergillus IgG

treat with VoraconAZOLE and maybe CaspoFUNGIN

93
Q

Actinomyces israelii is an anaerobic bacterium that usually causes infections where…

A

CervicoFacial infections from Actinomyces

94
Q

fever fatigue weight loss
pulmonary disease with cavitary nodules
nasal/sinus/ear symptoms
renal insufficiency and active urine sediment

think

A

GPA Granulomatosis with Polyangiitis

ENT Pulm Renal stuff…

95
Q

Amikacin belongs to this class of drugs that may be used to treat multi-drug resistant pyelo and can cause acute failure of this organ

A

Amikacin
Aminoglycoside
can cause ARF Acute Renal Failure (ATN not AIN)

96
Q

what kind of renal failure does Nafcillin cause, is it used in MDR pyelo

A

Nafcillin, AIN

MSSA not MDR organisms

97
Q

use Vanc to treat MDR pyelo?

A

probably not

Vanc for MRSA… MDR pyelo probably GNR

98
Q

TF

Vanc can cause nephrotoxicity

A

T at HIGH DOSES

99
Q

TF

Levofloxacin can cause renal toxicity

A

F

fluoroquinolones must be renally dosed but do not cause renal toxicity

100
Q

Doxycycline 4 common uses

A

CAP
Lyme…other zoonotic infections…
Chlamydia
Acne

101
Q

Azithromycin 4 common uses

A

CAP
Sinus Infections
Strep Pharyngitis
Chlamydia

102
Q

Aminoglycosides are used to treat ___

monitor for __toxicity

A

Serious Gram Negative Infections

monitor for Nephrotoxicity (ATN)

103
Q

TF

impaired lung expansion from pleural calcifications cause respiratory compromise in asbestosis patients

A

False
there are pleural calcifications but it is Pulmonary Fibrosis (Interstitial Lung Disease) that causes respiratory compromise

104
Q

TF

xanthelasma and hyperlipidemia are consistent with PBC

A

T

don’t ask me why

105
Q

TF

PBC can cause hepatomegaly with high Alk Phos but normal ast alt

A

T

106
Q

3 adverse effects of oxytocin

do they include uterine rupture

A

HypONatremia (oxytocin similar to ADHvasopressin)

HypOtenison

Uterine TachySystole - abnormally frequent contractions

(NOT uterine rupture really unless uterine abdnormalities, scars, multiple gestation, abnormal placentation)

107
Q

what is Vasa Previa

how can it affect mom and fetus

A

Vasa Previa - fetal blood vessels (yes, the cord) cross the fetal membranes between teh fetus and the inernal cervical os… then loop back in a longer path outside the membranes to the placenta…. instead of normally taking a more direct route not near the cervix

PAINLESS antepartum hemorrhage for mom

but RAPID DETERIORATION of FETAL HEART TRACING… because hemorrhage is of fetal origin

108
Q

placenta previa vs vasa previa – painful or painless – fetal heart tracing affected?

A

placenta previa - painless, no FHT effect

vasa previa - painless, FHT distressed (big fetal blood loss)

109
Q

pain with placental abruption?

A

umm YES distended and TENDER UTERUS with abruption

110
Q

diagnose vaginal lesion suspicious for vaginal cancer

A

biopsy that shit

111
Q

SCC vs Clear Cell Adenocarcinoma of the Vagina

age
risk factor
location
diagnose

A

SCC ^60yo Smoking HPV upper Posterior vagina

Clear Cell Adenocarcinoma in utero Diethylstilbesterol v20yo upper Anterior vagina

biopsy both

112
Q

why is vaginal breech delivery bad

what do you recommend instead

A

vaginal breech bad because higher fetal Asphyxia and Trauma

prefer External Cephalic Version or breech C-section

113
Q

what is internal podalic version of fetus

A

breech eg butt first.. reach in and deliver feet first

114
Q

presentation of Benign Intraductal Papilloma vs Infiltrating Ductal Carcinoma

A

unilateral Bloody nipple discharge Without mass or lymphadenopathy
- benign intraductal papilloma

pathologic nipple discharge but Mass and Lymphadenopathy
- infinltrating ductal carcinoma

115
Q

other symptoms to look for when trying to attribute seizure to hypoglycemia

A

Hanger - anxiety, tremor, cognitive impairment, diaphoresis

116
Q

why can S3 be normal in young folk and athletes

A

from splash into large left ventricle…. fast depol and relaxation causes suck-splash?

otherwise think chf…

117
Q

TF

Lupus flare during pregnancy is a thing

A

T
Increased Risk of Lupus Flare in Pregnancy and Postpartum

causes obstetrical complications such as preeclampsia, premature birth, c-section, growth restriction, fetal demise

118
Q

signs of Lupus Flare as cause of pregnancy proteinuria rather than preeclampsia

A

lupus stuff: associated joint pain, malar rash, bloody casts in urine, decreased complement levels, incraesed ANA titers

119
Q

Hemolytic Uremic Syndrome presents with ___ ___ and ___ most often due to ___

A

Hemolytic Uremic Syndrome presents with Renal Injury, Thrombocytopenia and MAHA Microangiopathic Hemolytic Anemia most often due to Shiga Toxin producing E.Coli

120
Q

TF
hepatitis and panlobular mononuclear infiltration with hepatic cell necrosis on biopsy is consistnent with Isoniazid side effect eg in the treatment of pulmonary TB

what other drugs also do this

A

T
this is what Isoniazid-Induced Hepatic Cell Injury looks like….
Idiosyncratic Liver Injury with Histological Features Similar to Viral Hepatitis

Isoniazid, Halothane, phenytoin, alpha methyl dopa….

just watch out for hepatic stuff after starting drugs…

121
Q

how often to screen healthy 70yo lady with

mammogram
lipid panel
blood pressure
DEXA scan

A

in old lady

mammo q2 age 50-74
lipid panel… no just q5 for men over 35 and women at high risk over 45

BP q2
DEXA for osteoporosis at least once over 65

122
Q

treat VTach

A

IV Amio of stable

Cardioversion if unstable or severely syptomatic

123
Q

carotid sinus massage useful for what arrhythmia

A

PSVT
paroxysmal supraventricular tachycardia
(narrow complex)

124
Q

digoxin for what arrhythmia

A

afib aflut atach

125
Q

pt diagnosed previously with chronic bronchitis but seeming more like bronchiectasis now (less smoking with little production and viral exacerbations, more difficulty clearing tons of mucus with bacterial infections and sinus congestion…)

workup?

A

high resolution chest CT #1 best test for bronchiectasis

Immunoglobulin quantification

CF testing, sputum culture

PFTs

126
Q

chronic bonchitis vs bronchiectasis

smoking
sputum production
viral vs bacterial
antibiotics

A

chronic bronchitis - smoking, small sputum, viral exacerbations

bronchiectasis - copious sputum production, bacterial exacerbations, antibiotics

127
Q

“linear atelectasis” on cxr suggests…

A

bronchiectasis

128
Q

cxr linear atelectasis, dilated and thickened airways, irregular peripheral opacities

hrct bronchial dilation, lack of airway tapering, bronchial wall thickening

diagnosis?
pathogenesis
obstructive?

A

bronchiectasis
airway/bronchial dilation from recurrent infection, inflamation, tissue damage from bacterial infections with impaired clearance
yes, obstructive

129
Q

most common cause of Massive lower GI bleed

hemorrhiods?

diagnose
treat

A

Diverticulosis

(hemorrhoid bleeds rarely massive)

diagnose diverticular bleed with colonoscopy

most diverticular bleeds spontaneously resolve, if not, endoscopic or surgical therapy

130
Q

diverticulosis most common in the ___ colon but diverticular bleed most common in the ___ colon

A

diverticulosis left colon
but diverticular bleeds more common right colon

so may get a little darker, maroon

131
Q

___ causes sudden onset abdominal pain and tenderness followed by rectal bleeding…. due to inadequate perfusion of watershed area of colon (splenic flexure) in setting of nonocclusive ischemia or surgical intervention

A

ischemic colitis

132
Q

indoor barbecue, headaches nausea vomiting abdominal pain confusion coma pinkish-red skin hue

think
get
treat

A

CO poisoning
Carboxyhemoglobin level
Hyperbaric oxygen

133
Q

bitter almond breath is characteristic of inhaled ___

A

bitter almond breath is characteristic of inhaled Cyanide

134
Q

drug or environmental exposure, headache nausea vomiting abdominal pain confsion coma bluish discoloration of skin and mucous membranes

think

A

methemoglobinemia

135
Q

CO poisoning vs Methemoglobinemia

skin color?

A

CO Pinkish-red skin

Methemoglobinemia Bluish cyanosis

136
Q

plaque-like reddish-brown velvety lesions at intertriginous areas without cyst formation think

A

condylomata lata

secondary syphilis

137
Q

young guy with agitation, dilated pupils, atrophic nasal mucosa, htn, MI

think
pathophys
treat with 4
avoid 2

A

cocaine
block norepinephrine reuptake by sympathetics, increased sympathetic alpha and beta adrenergic stim, hr bp cardiac oxygen demand, coronary vasoconstiction, platelet activation

Supplemental O2 and IV BENZODIAZEPINE… reduces sympathetic outflow
ASPIRIN
NITRATES and CCBs

avoid bb’s… can unappose alpha and worsen coronary vasoconstriction
avoid thrombolytics unless STE like always

138
Q

all patients with acute cocaine toxicity and myocardial ischemia should be treated initially with supplemental oxygen and ___

A

IV Benzodiazepines for cocaine toxicity.

…reduces sympathetic outflow and symptoms

139
Q

empiric treatment of CAP

outpatient healthy
outpatient comorbidities
inpatient
ICU

A

Macrolide or Doxy if healthy outpatient

respiratory fluroquinolone (Levofloxacin or Moxifloxacin) or Beta Lactam and Macrolide (Ceftriazone and Azythromycin) if comorbidities outpatient or inpatient (IV if inpatient)

Beta Lactam and Macrolide (Ceftriaxone Azythromycin) or
Beta Lactam and Fluoroquinolone (Ceftriaxone and Levo or Moxi)
IV if ICU

140
Q

to admit for CAP?

A 
CURB-65
Confusion
Urea (BUN) ^20
Respiratory rate ^30
BP v90/60
^65yo

outpatient if 0
admit if 1-3
prob ICU if 4-5

because mortality

141
Q

define excess alcohol

define binge drinking

A

excess ^2 drinks per day

binge ^5 drinks at a time

142
Q

what does FeNa v1% tell you about AKI

A

likely prerenal

kidneys retaining most sodium and fluid, not excreting in urine

143
Q

TF

prerenal AKI can lead to ATN

A

T

144
Q

lactational mastitis

pathophys
bug

how do myalgia chills malaise change management? erythema and tenderness in one quadrant but no fluctuance?

treatment?

A

sin fluora or infant oral fluora multiplying in stagnant milk ducts
Staph Aureus most common

myalgia chills malaise common, do not change management, neither does tenderness localized to one quadrant without fluctuance

  • still Keep Breastfeeding (for infant nutrition and to treat mastitis, better than pumping)
  • Analgesia
  • anti-MSSA abx Dicloxacillin or Cephalexin… if MRSA Clindamycin TMPSMX or Vancomycin
145
Q

2 keys to differentiating between cholecystitis and cholangitis

total / direct bili? transaminases?

A

cholangitis will have additional Jaundice and Higher Alk Phos

not bili so much… cholecystitis can cause mild transaminase elevations and bili elevation up to 4 mg/dl

146
Q

treat PBC

if elevatged Alk Phos and anti-mitochondrial antibody but asymptomatic?

if PBC advanced?

A

early, even asymptomatic PBC - URSODEOXYCHOLIC ACID… limits bile injury to bile duct and antiinflammatory and immunomodulatory

if advanced PBC with cirrhosis - LIVER TRANSPLANT

147
Q

TF treat PBC with steroids

A

F
treat PBC with Ursodeoxycholic acid
(treat AI Hepatitis with Steroids)

148
Q

___ should be initiated as soon as diagnosis of PBC is made

A

Ursodeoxycholic acid

should be initiated as soon as PBC diagnosed, even if asymptomatic… limits bile duct injury and has antiinflammatory and immunomodulatory effects

149
Q

best test to diagnose acute Hep B infection

A

HBsAg and anti-HBc IgM

HBsAg is the Ag that occurs early with other Ags in infection but lasts the longest

anti-HBc IgM because covers window period in which HBsAg vanishes but anti-HBs is yet to arise

  • HBcAg is not detectible in serum
  • HBeAg demonstrates INFECTIVITY but levels fall early so HBsAg a better marker of infection

HBV DNA used in chronic HepB to indicate antiviral treatment and monitor response

150
Q

TF

esophageal rupture possible with vomiting

A

T

it’s called Boerhaave syndrome

151
Q

in smoker with chronic cough and small sputum production exacerbated by URTIs, also with dyspnea, decreased vital capacity on PFT, which of the following is true?

alveolar-capillary membrane thickening

decreased FRC

air trapping with expiration

decreased lung distensibility

A

This patient has cOpd - bronchitis (chronic cough smoker some sputum urti viral exacerbations) and emphysema (dyspnea)
OBSTRUCTIVE

so Air Trapping

not alveolar thickening - destruction
not decreased frc - increased frc.. cannot get air out
not decreased distensibility - increased lung distensibility

152
Q

hypercalcemia associated with which lung cancer

A

SCC
sCa++mous cell carcinoma
PTHrp

153
Q

TF

suspect TB in USA non-immigrant with unilateral hilar mass and hypercalcemia

A

F
not so much, TB rare in USA unless immunosuppressed

think more SCC squamous cell carcinoma of the lung

154
Q

TF

small cell lung cancer causes hypercalcemia via PTHrp

A

F
SCLC - SIADH and ACTH

Squamous cell carcinoma SCC - PTHrp
sCa++mous cell carcinoma

155
Q

TF

suspect sarcoidosis in unilateral hilar mass and hypercalcemia

A

F
think more SCC squamous cell carcinoma of the lung PTHrp

think sarcoid if Bilateral hilar masses and erythema nodosum

156
Q

treat / prevent uric acid ureteral stone

A

hydration
Alkalinize Urine to pH 6-6.5 with Potassium Citrate
Allopurinol if recurrent despite above

157
Q

thiazide diruetic, loop diuretic, or potassium citrate to treat uric acid kidney stone?

A

Potassium Citrate to treat Uric Acid stone – K Alkalinizes urine to pH 6-6.5, Citrate inhibits stone formation

thiazides decrease Calcium stone formation

loops increase calcium stone formation… bad…

158
Q

most common cause of aortic regurge

developing countries

developed countries

A

developing country AR - rheumatic heart disease

developed country AR - bicuspid aortic valve, aortic root dilation

159
Q

most common electrolyte abnormality in alcoholism and how does it cause refractory hypokalemia

A

hypomagnesemia most common in alcoholic

normally inhibits K+ secretion by kidney, so low magnesium makes hard to replete K+ because kidney just excretes it

160
Q

low albumin causes __ total calcium, because…

A

low albumin LOW total calcium… because lots of calcium is protein bound

161
Q

adult patient with nephrotic proteinuria and anasarca gets acute flank pain and hematuria

caused by
why
renal biopsy most likely shows

A

caused by Renal Vein Thrombosis

nephrotic proteinuria loses Antithrombin III

possible with any nephrotic syndrome but most common with MG Membranous Glomerulonephropathy

RVT MG

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