STEP 2 - UWORLD Flashcards
how to prevent stones
increase fluids, decrease Na in diet, decrease protein in diet, normal Ca an duse thiazide diuretcs
infections from joint replacements, < and > 3 months
< 3 months = s aureus
> 3 months = s epi
post cholecystectomy syndrome - test
ERCP
early diastolic murmur with hyperdynamic or water hammer pulse
AR
next step for pt who is mildly hypercalcemic
check PTH first
hormone produced in adrenal tumor in women
DHEAS
why does DHEAS producing tumor also have decreased LH
negative feedback
child with hip pain after URI
transient synovitis
child with hip pain, negative XR, fixed, slightly abducted externally rotated limb
transient synovitis
you suspect transient synovitis - what do you do next and what do you rule out
legg-calves-perth disease with XR of hip
hyperoxaluria found in what dz
crohns
recurrent candidiasis in older woman
check A1c
pt has minor symptoms but also lung consolidation, what now
CXR and empiric abx - chance of bacterial conversion is high
gene with MEN2a/b
RET proto-onco genes
medullary thyroid CA and pheochromocytoma
MEN2a/b
heart problems (3) with Turners
bicuspid aortic valve
aortic coarctation
aortic root dilation
tumor in precocious puberty in female
granulosa cell
ovarian mass
MCC of congenital hypothyroidism
thyroid dysgenesis
type of dysfunction in Zenkers
motor - sphincter/esophageal dysmotility
pathophysiology of Zenkers
posterior herniation bt fibers of cricothyroid muscle
35 year old woman with infertility and hypothyroidism
premature ovarian failure
hormone levels in premature ovarian failure
increased FSH, decreased estrogen, increased GnRH
gross hematuria w/i 5 days of URI and normal complement levels
IgA nephropathy
gross hematuria 2-3 weeks after URI with low C3 and C3 deposits on kidney bx
post infectious glomerulonephritis
MCC of glomerulonephritis
IgA nephropathy
sudden contralateral sensory loss with ballistic movements
thalamic stoke (proximity to BG)
burning pain on same side as sensory loss 4 weeks after stroke
thalamic pain syndromw
Bipolar pt with renal failure or BUN/Cr elevation - medication choice?
valproate
test of choice in suspected pancreatic CA
ab CT
pituitary necrosis from ischemia
Sheehan syndrome
hypotension, lethargy, weight loss 2/2 ACTH impairment
Sheehan syndrome
endometrial hyperplasia from medication
tamoxifen
effect of long term NPO on gall bladder
stasis»_space; gall stones
fever, leukoctosis, LUQ pain and chest pain
splenic abscess with left sided endocarditis
diagnostic reqs for acute liver failure
ALT/AST >1000
hepatic encephalopathy
INR >1.5
what can retropharyngeal abcess become that is worse and how
necrotizing mediastinitis, through alar fascia
Looks like pericarditis, you want to do pericardiocentesis, but make sure you check WHAT first
the fucking BUN, if it’s >60 then it’s uremic pericarditis
6 week old baby with some odd facial features has loud S2, systolic ejection murmur
AV septal defect
how to calculate TTKG
(urine K/serum K)/(urine osm/serum osm)
<2 vs >4 TTKG means?
<2 = nonrenal reason for hypokalemia >4 = renal reason for hypokalemia
renal bicarb secretion depends on
counter transport of Cl
calculate the osmolar gap
osmolarity - (2[Na] + glucose/18 + BUN/2.5)
what does a osmolar gap of >10 mean
toxic ethanol ingetsion
metabolic derangement in acetazolamide use
increased Cl and decreased K
lepirudin, dabigatran, argabatran are what
direct thrombin inhibitors
when can you use direct thrombin inhibitors
NV Afib, VTE prophylaxis, HIT
corrected anion gap
anion gap + (4 - [albumin] x 2.5)
metabolic changes with thiazide diuretics
decreased K, Na, H
increased glucose, lipids, uric acid, Ca
treatment for CAP
IP: ceftriaxone + azithromycin OR moxifloxacin
OP: Azithroymcin
treatment for HAP
Vanc/Zosyn
treatment for PCP
Bactrim +/- steroids (decreased PaO2 or hypoxic)
treatment for bronchitis
macrolide/doxy/FQ or nothing
young man with knee catching after a game
meniscal tear - MRI»_space; surgery
ischemic colitis after what kind of surgery
vascular/AAA repar
CT shows thickening of bowel wall
ischemic colitis
stroke without hemiparesis or sensory loss
likely hemorrhagic
cerebellar hemorrhage
ipsilateral hemiataxia
atypical depression in a smoker not treated before
buproprion, not MAOI
if no fetal heart tones on doppler
U/S for fetal demise
next step for mom and baby after fetal demise
baby - autopsy for karyotype/genetics
mom - antiphospholipid syndrome/fetomaternal hemorrhage
toxicity of trasztusamab
cardiotoxicity - do ECHO frequently
angular chelitis, glossitis, stomatitis, normocytic/chromic anemia, seborhic dermatitis
B2 riboflavin def
HZ on both eyes?
still fucking HZ even though it shouldn’t be
water bottle shaped heart with no maximal impulse point
cardiac tamponade
pt with mono and really sore throat at risk for
acute airway obs, could be at risk for peritonsilar abscess but NEVER retropharyngeal abscess
pt is strep, 3 yrs old and has swallowing problems
retropharyngeal abscess
don’t choose retropharyngeal abscess unless
pt is <4 or had recent trauma
DOE, orthopnea, choking on laying down, lower ext edema
diastolic dys with preserved EF
methimazole s/e
agranulocytosis
PTU s/e
liver failure
which Graves disease drug in 1st trimester
PTU
sore throat and fever while taking methimazole
agranulocytosis
pt with STEMI, give MONA BASH unless flash pulmonary edema then give
loop
difference bt seminomitous vs nonseminomatous tumors
semi - Bhcg
non-semi - Bhcg and AFP
spider angiomas, palmar erythema, gynecomastia, testicular atrophy
hyperestinism in cirrhosis
vascular wall dilation in cirrhosis
estrinism
frequent watery nocturnal diarrhea
possible laxative abuse
malanosis coli/dark brown spots on proximal colon
laxative abuse
menarche should start during what tanner stage
4
postpartum with signs of PE
go straight to anticoag
painless episodes of GI bleeding
angiodysplasia
MC place for angiodysplasia
R colon
angiodysplasia often co-occurs with what other disorder
AS
treatments for PAD
exercise»_space; cilostozol»_space; revascularization
blood problems in scleroderma
schistocytes
schistocytes, AKI, thrombocytopenia, malignant HTN
scleroderma
mcc of second stage arrest of labor
fetal malposition
vaccines 2 year old sickle cell patients need
PPSV23 and MCV4
reason for hypoCa in pancreatitis
precipitation of calcium soaps
FAST scan cannot see what areas
retroperitoneal or other peritoneal bleeds - it’s good for splenic but not kidney or aorta or pancreas
treatment for bacterial rhinosinusitis
augmentin (levo is as effective but has poorer s/e panel)
3 relatives, 2 generations, 1 before 50
Lynch, HNPCC
types of cancer in HNPCC
endometrial and colon
genetic failing in HNPCC
DNA mismatch repair with microsatelitte
tx for cholestasis of pregnancy
ursodeoxyacid, deliver at 36 weeks
CENTOR score
C - no cough (1 pt) E - exudates (1 pt) N - node involvement (1 pt) T - temp over 39 OR - <14 (1 pt) or >44 (-1pt)
<1 = nothing
2-3 rapid strep
>4 = rapid strep and treat regardless
location of b/l nose bleed
posterior - use packing
major/minor Duke criteria for IE
Maj: bacteremia, new onset regurg, vegetations
Minor: RF, fever, vascular, rheumatological
Tx for IE/SBE
native valve: vanc ONLY prosthetic valve <60d: vanc + gent + cefipime 61-364 days: vanc + gent >365 days: vanc + gent + ceftriaxone SBE: gent + ceftriaxone
Imaging modality for IE
TEE
when is surgery indicated for IE
florid CHF, veg >15mm, veg >10mm + embolism, stroke or MI, fungus, abscess
can’t give vanc in IE?
daptomycin
how long to treat IE/SBE for
4-6 weeks
increased Uosm and Una
SIADH
treatment for SIADH
demeclocycline to induce DI
Uosm is decreased and urine is dilute
DI
dx for DI
Deprive the Internal water
decreased serum Na and decreased serum Osm
SIADH from too much ADH
Not enough ADH
DI
euvolemic hypotonic hyponatremia causes
RATS
RTA, Addisons, thyroid, SIADH
how to deal with symp vs non symp SIADH
symp - water deprivation
non-symp - CT scan
what to check in euthryroid sick syndrome
rT3
thyroglobulin differences bt biologic and medically induced hyperthyroid state
biologic = increased induced = nonexistant
thyroid finding in recurrent miscarriage
antiTPO ab
most common factor in CP
prematurity
MCC of sepsis in fully vaccinated SS child
s pneumo
lesion of facial nerve: below vs above pons
below - Bell’s palsy
above - forehead sparing, may have hemiplegia, hemisensory loss
small for gestational age child with hearing loss and cataracts
congenital rubella
pt with HF and hx of MI
left ventricular aneurysm
deep Q waves and persistant ST elevation on EKG
left vent aneurysm
iron deficiency anemia and malabsorption
celiac
suspected celiac pt without IgA antiendomysial ab
could still be, maybe they’re selective IgA deficiency
movement of blood from high pressure aorta to low pressure pulmonary artery results in this murmur
PDA
mildly accentuated peripheral pulse
PDA
s/e of ICD
TR
hormonal derangement in OSA
increased EPO
increased renin, increased aldo in hypoK and HTN
secondary hyperaldosteronism - probably renovasular
decreased renin, increased aldo in hypoK and HTN
primary hyperaldosteronism - probably adrenal hyperplasia or aldosterone secreting tumor
decreased renin and aldo with hypoK and HTN
non aldosterone cause - probably CAH, cushings, exogenous mineralocorticoid
HTN, mild increase in Na, decreased renin
primary hyperaldosteronism
tx for allergic rhinitis
intranasal glucocorticoids
gram positive filimentous acid fast bacteria with brain abscess and lung involvemnt
nocardia - use bactrim and carbapenam if brain involvement