Random UWorld Questions Flashcards
Dx: fever, recent cruise, SOB, confusion, relative brady (given fever), hyponatremia, transaminitis, hematuria and/or proteinuria
think legionella (check Urine antigen test)
tx for legionella
macrolide or FQ
Examples of viridans strep species?
S. mutans, S. mitis, S. milleri, S. oralis, S. sobrinus and S. sanguinis
S. bovis bacteremia, think?
Inf endocarditis d/t colon cancer or IBD lesion (specifically S. bovis biotype 1 a.k.a. S. gallolyticus)
Causes of a LOW anion gap?
re-call that AG = unmeasured anions - unmeasured cation, so LOW anion gap means HIGH unmeasured cations (e.g. Ca, Mg, K, Li, bromine or Igs OR low albumin -> decr binding sites for cations)
Initial work-up for metabolic acidosis?
- Check anion gap
2a. If incr Gap -> calc ∆∆, OG Gap, check ketonuria
∆∆ = (∆AG/∆HCO3) | ∆AG = (calc AG - measured AG)
∆HCO3 = (24 - HCO3)
∆∆ = 1-2 then pure AG metab acidosis
∆∆ 2 then AG metab acidosis PLUS metab ALKalosis
—OG Gap (measured SOsm - calc’d SOsm)
Calc’d Osm = 2Na + gluc/18 + BUN/2.8
OG > 10 -> ingestion likely
2b. If Non-Gap -> check UAG = [(U_Na +U_K) - U_Cl]
—negative UAG -> appropriate renal NH4+ excretion
——DDx: GI causes, proximal RTA, early renal fail
—positive UAG -> failure of kidneys to excrete NH4+
——DDx: distal (low serum K+) of hypoaldo RTA (high serum K+) or early renal failure
Kussmaul’s sign and its association
JVP fails to decrease or actually increases during inspiration (paradoxical behavior); associated with constrictive cardiac issues (e.g. constrictive pericarditis)
Diamond Criteria for CP
- L-sided chest pain
- worse w/ exercise
- at least some relief w/ rest + NTG
—ALL 3 = typical, 2 = atypical, 0-1 = non-anginal
anti-pseudomonal abx by class
penicillins (pip, ticaracilin), cephalosporins (ceftazidime [3rd], cefipime [4th]), AGs (gent, tobra, amikacin), FQs (cipro and levo), monobactams (aztreonam), and carbopenems (mero- and imipenem)
drugs that cause folic acid deficiency
some AEDs (phenytoin, primidone, phenobarb), TMP/SMX, and MTX
isoniazid causes what vitamin deficiency?
b6
classic physical exam findings for cardiac tamponade?
Beck’s Triad: hypotension, JVD and muffled heart sounds (in a non-obese pt)
Absolute contra-indications to combined hormonal OCPs
migraine w/ aura Stage II HTN (BP > 160/100) Smoke >15 cigs/d & 35+ y/o H/o VTE H/o stroke or ischemic heart dz Breast cancer Cirrhosis/liver cancer Surgery w/ prolonged immobilization
Erythema nodosum is most common in ___ and if not primary can be a warning sign of ____?
women 15-40 y/o; relatively benign and heals on its own in a few weeks
—most commonly due to recent strep infection (culture) or sarcoidosis in black women (get CXR)
—TB, histoplasmosis, or IBD
Most common HIV-associated kidney disease?
focal and segmental GN (a.k.a. HIV-nephropathy); occurs even in pts on tx despite normal CD4 count; more common in blacks for unknown reason
S4
“TEN-nes…see”; (S4-S1…s2) signifies stiffened LV c/w diastolic HF; due to the artial kick at the end of diastole “kicking” the residual blood from the LA onto a stiffened LV
MEN 1
[P]rimary hyperPTH (>90%), [P]ancreatic/upper GI (60-70%), [P]ituitary adenomas (10-20%)
- Panc/UGI: gastrinoma, insulinoma, VIPoma (diarrhea, hpyoK, hypoCl), glucagonoma (hyperGLY, necrolytic migratory erythema
Milk alkali presentation
hypercalcemia, decreased renal function, metab alkalosis
top 3 cancers that met to the liver
breast, lung and GI
Indications in CEA for men vs. women
Women: cut when occlusion > 70% regardless of sx
Men: w/ sx cut > 50%, w/o cut >60%
Equation for NNT = ?
NNT = 1/ARR, where ARR = Incidence (grp 1) - Incidence (grp 2)
Pathophys of hyperoxaluria leading to stones?
Starts w/ poor lipid absorption in gut -> Calcium binds lipids instead of their usual habit of binding to oxalte -> Oxalate is no longer bound to calcium and can therefore be absorbed.
Light’s Criteria for Pleural Fluid Analysis
Exudate if
- fluid_prot : serum_prot > 0.5 OR…
- fluid_LDH : serum_LDH > 0.6 OR…
- fluid_LDH > 2/3 ULN for serum
Causes of hyperthyroidism w/ low radio-iodine uptake?
In decreasing order of commonness:
- subacute, painless thyroiditis
- granulomatous (deQuervain’s) painful thyroiditis
- iodine-induced thyrotoxicosis
- levoTHY o/d
- pigs flying
- struma ovarii
Tx for CLL?
chlorambucil and prednisone
Tx for NHL?
CHOP: [C]yclophosphamide, [H]ydroxydanurubicin, [O]ncovin (vincristine), [P]rednisone
Tx for hairy cell leukemia?
Cladribine
Tx for thyroid storm?
- B-blocker
- PTU –1hr–> iodine (stop synth of new thyroxine)
- glucocorticoids: stop periph T4->T3 conversion
B-blocker toxicity, s/sx? Tx?
AV block, brady, hypoTN, WHEEZING (unique vs. CCBs); Tx w/ IV glucagon
Digoxin toxicity
GI: anorex/n/v/abd-pain
Neuro: COLOR DISTURBances, weak/fatigue/confused
Imaging test to do when you suspect myasthenia gravis?
CT chest: look for thymoma (present in 15% of these pts)
Criteria for admitting pt w/ PNA?
CURB-65 Confusion Uremia (BUN >20) Resp rate >30 BP
WBC in joint fluid?
0-200/mL - normal
2000-50000/mL - inflammatory
>50,000/mL - septic arthritis
Time cut-off for alteplase in presumed embolic stroke?
Must be given within 3-4.5 hours of sx onset
anti-platelet for stroke pt not on any anti-plt?
ASA
anti-platelet for stroke pt on ASA?
ASA + dipyridamole OR clopidogrel
anti-platelet for stroke pt w/ large vessel intracranial atherosclerosis
warfarin, dabigatran, rivaroxaban
attributable risk percentage (ARP) = ?
(RR - 1)/RR
6 classic criteria for OA as cause of knee pain
Specificity 69% for 3+ of: 1. > 50 y/o 2. crepitus 3. bony enlargement 4. bony tenderness 5. lack of warmth 6, lack of morning stiffness
Definition of orthostasis?
Appropriate reflex tachy PLUS SBP drop >20 OR DBP drop > 10 after 3mins
Tx TCA poisoning
Oral charcoal if past 2 hours, sodium bicarb for QRS prolongation
Enzyme to check when concerned for recurrent MI in the days following original MI?
CK-MB b/c it normalizes in 1-2 days vs. Troponin T which takes 10 days to come down.
Name other heritable hypercoag states besides Factor V Leiden?
Protein C or S deficiencies, antithrombin III deficiency, plasminogen d/o
Most common cause of nephrotic syndrome in patients with solid tumors?
membranous GN
Nephrotic syn assoc’d w/ Hodgkins lymphoma?
minimal change disease
Nephrotic syn assoc’d w/ URI?
IgA nephropathy
Amyloid kidney disease is assoc’d w/ which malig?
multiple myeloma causing amyloid nephrotic syndrome
Pressure measurement to dx pHTN?
Pulm art. pressure > 25mmHg at rest of >30 mmHg w/ exercise
Causes of avascular necrosis of the femoral head in adults?
long-term corticosteroid use, hemoglobinopathies, EtOHism
Wells’ Criteria for PE?
Clinical S/Sx of DVT (3) No other dx as likely (3) Immob 3d or surg in past 1m (1.5) HR > 100 (1.5) Prior PE/DVT (1.5) Hemoptysis (1) Malig tx'd in last 6m (1)
Metal most likely to cause contact dermatitis (a Type IV hypersensitivity)?
nickel
Most common mutation seen in PV pts?
JAK2-V617F
Lone focal neuro finding you can seen IIH (pseudotumor cerebri)?
CN VI (abducens n.) palsy
Most feared complication of anti-thyroid medications?
Both methimazole and PTU can cause agranulocytosis. If pt on these meds comes in w/ fever and sore throat, start broad-spectrum antibiotics w/ pseudomonal coverage.
thrombocytopenia and hemolytic anemia w/ no apparent cause?
Like TTP, get periph smear (expect schistocytes) and start empiric plasma exchange. Underlying cause is ADAMTS13 protease deficiency. Most cases idiopathic or drug-related, but assoc’d w/ HIV, too.
study method to determine prevalence vs. study method to determine incidence?
prevalence: cross sectional study
incidence: cohort study (either retro- or pro-spective)
Stats test to compare two proportions?
chi-square test
Stats test to compare two means?
two sample t-test (done on means from a sample) or z-test (done on means from a population)
Early onset Alzheimer’s is associated with?
Trisomy 21
Name for infection of the lacrimal sac?
dacryocystitis (usually S. aureus or b-hemolytic Strep)
chalazion vs. hordeolum
hordeolum = painful infection (usu S. aureus); chalazion = painless, chronic, granulomatous inflammation of a meibomian gland
Treatment for neuroleptic malignant syndrome?
1st line - dantrolene
other options: bromocriptine (dopa-antagonist), amantadine (antiviral w/ anti-dopaminergic properties)
Hemophilia A pathophys? Inheritance pattern? Dx?
Factor VIII deficiency (X-linked recessive); prolonged aPtt
Hemophilia B pathophys? Inhertiance pattern? Dx?
Factor IX deficiency (X-linked recessive); prolonged aPTT
Anticholinergic overdose mnemonic
“hot as a hare” “blind as a bat” (acute glaucoma) “dry as a bone” “red as a beet” “mad as a hatter” “full as a flask”
selegiline MoA?
MAO-B inhibitor for Parkinson’s; can cause serotonin syndrome when co-administered with SSRIs or TCAs
bromocriptine MoA?
dopamine agonist used in tx of Parkinson’s, pituitary tumors, neuroleptic malignant syndrome and hyperprolactinemia
trihexyphenidyl MoA?
anticholinergic for tx of PD or EPS side effects
Advanced sleep phase disorder?
[A]dvanced = Uncle [A]l (can’t stay awake until after 7-8pm and then wake up early)
Delayed sleep phase?
Gui (can’t fall asleep until 4-5a, but can sleep normal 8 hrs if able to)
At what diameter would you biopsy asymptomatic cervical rubbery nodes?
> 2 cm, sooner if pt developed systemic sx
normal liver span?
6-12 cm in MCL
triad of granulomatosis with polyangitis? test?
a.k.a. Wegener’s Granulomatosis: present with GN, lower and upper airways granulomatous inflammation and vasculitis | can see nasal bridge destruction, pyoderma gangrenosum | Positive C-ANCA
DDx of normotensive pt w/ hypokalemia and alkalosis
- surruptitious vomiting
- Diuretic abuse
- Bartter syndrome (resembles loop diuretic use)
- Gitelman’s syndrome (resembles thiazide use)
Five Hs and Five Ts of reversible causes of PEA?
Hs: hypoxia, hypovolemia, hypo/hyperkalemia, hypothermia, hydrogen ions (acidosis)
Ts: TNX, tamponade, toxins (narcs, benzos), thrombosis (PE, MI), trauma
False positive VDRL in pregnancy
think APS and treat w/ heparin
B12 vs. Folate deficiency
Both cause megaloblastic anemia, but only B12 causes neuro sx, so important to know which it is before treating.
—B12 will have elevated homocysteine AND methylmalonic acid vs. Folate is homo only (B12 is “bi” symptoms and “bi” test results)
Tx and prophylaxis for cluster headaches?
Tx: subQ sumatriptan and oxygen
PPx: ergotamines, lithium, and/or verapamil
Presentation of cluster HAs
sudden onset of severe retrorbital HA in males assoc’d w/ ipsilateral Horner’s syndrome
Action of aldosterone
[s]aves [s]odium, wastes K+ and H+ (causing metabolic alkalosis)
Lambert-Eaton is most commonly associated with?
Small Cell Lung Cancer (abs against presynaptic, voltage-gated calcium channels)
technical name for PCP?
phencyclidine
right-sided systolic murmur increases w/ inspiration?
TR (as in IVDU endocarditis patients)
MRI finding in Huntington’s?
atrophy of the caudate nuclei (shows up as widened lateral ventricles)
dex for meningitis due to which pathogen? how many days?
s pneumo only; 4 days; d/c if other bug comes back
Rx to alkalinize urine in uric acid stone pt?
potassium citrate
Two most common causes of nephrotic syndrome in adults w/o other systemic illness?
focal-segmental glomerulosclerosis and membranous nephropathy
Give one instance where RBC count matters
In differentiating between iron-def anemia and alpha- or beta-thalassemia minor:
- Fe-def RBCs - low
- thalassemias minor - normal
Mnemonic for eosinophilia?
NAACP: [N]eoplasm, [A]ddison’s (panhypopit, etc.), [A]llergy, [C]ollagen Vasc Dz/[C]holesterol emboli, [P]arasites
NF-II?
café-au-lait spots and (?unilateral) acoustic neuromas
Meds that cause hyperK+ and their mechanisms?
- non-selective BBs (block B2-mediated cell K+ uptake)
- ACE/ARBs and K-sparing diurectis (aldo/ENac)
- Dig (interrupts Na-K-ATPase)
- cyclosporine (blocks aldo activity)
- heparin (blocks aldo production)
- NSAIDs (decr renal perfusions -> decr K deliv to CDs)
- succhinylcholine (K+ leak from AChR’s)
PBC Ab?
anti-mitochondrial
drugs that cause drug-induced esophagitis?
ASA/NSAIDs; KCl, Fe, quinidine; tetracyclines; alendronate
HIV opp infxs by CD4 count? PPx Rx?
Mechanism by which EtOH exacerbates gout?
EtOH -> lactacte -> competes for urate excretion in the kindey -> incr serum [urate] -> joint accumulation -> flair
Which vitamin deficiency causes Wernicke’s encephalopathy? Typical sx?
thiamine (B1) [ ¡NOT COBALAMIN (B12)! ] B12 does cause peripheral neuropathy, but not Wernicke’s sx of: ophthalmoplegia, ataxia, confusion
Low back pain red flags? Work-up
> 50 y/o, h/o malig, trauma, no imprvmnt 1 mo, night-time pain/wakens from sleep, neuro sx, constitutional sx, IVDU
—If pt has these + cord compression sx -> MRI
—If no cord compression sx -> plain XR w/ ESR
—If none of these, observe 4-6wks NSAIDs/PT
SAAG interpretation?
> 1.1 g/dL - likely d/t portal HTN
neutrophil count in ascitic tap to be c/w SBP?
> 250/uL
