STEP 2 - UWORLD part 2 Flashcards by Catherine Craven

normally aldo does what

acts on the DCT/CD to reabsorb Na and secrete K/H into urine

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common infections in cushings

nocardia, PCP, fungal

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primary vs secondary hyperparathyroidism

primary - hypercalcemia

secondary - hypocalcemia

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MC presentation of hyperparathyoidism

asymptomatic hypercalcemia

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MCC of secondary hyperparathyroidism

CKD

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increased phos, low ca, low vitamin d

tertiary hyperparathyroidism

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how to stimulate PTH normally

if you have elevated phos, low ca, and low calcitriol

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CKD and increased PTH

restrict dietary phos, Ca based phos binder, vitamin D

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labs in primary hyperparathyroidism

increased Ca and hypercalciuria
increased or NL PTH
hypophosphatemia

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multifocal subperiostal bone reabsorption in distal phalanges on radiograph

primary hyperparathyroidism

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> 50000 WBC on joint tap

septic joint

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cloudy jiont tap, >2000WBC, 50% PMNs and +/- crystals

inflammed joint

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antismooth muscle antibody

Lupus

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11 things you need to have lupus (only need 4 of them)

Malar
Discoid

Serositis
Oral ulcer
Arthritis
Photosensitivity

Blood decreaed Hgb and pH
Renal failure
ANA+
Immunologic
Neuro

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decreased C3/C4 in someone with a malar rash and fever

SLE

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SLE tx

hydroxychloroquine
steroids during a flare
IV cyclophosphomide at beginning of nephritis
mycophenelate for nephritis after

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MCC of drug indiced SLE

hydralazine

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dsDNA

lupus nephritis

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do you need to bx a suspected lupus nephritis

yes

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first test for lupus

ANA

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what joints does RA go for

RAlly small ones but never DIP

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Arthritis that covers >3 joints, spares the DIP joints, morning stiffness lasts for >60 mins

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cholesterol nodules on fingers

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periarticular osteopenia on radiograph

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alternatives to MTX in RA

leflunimide unless pregnant then hydroxychloroquine

RA + splenomegaly + neutropenia

Felty's

hands and face are tight, pt has GERDq

CREST (limited scleroderma)

tight face + GERD + constrictive pericarditis + renal problems

diffuse scleroderma

treatment for calcinosis and raynauds parts of CREST

CCBs

treatment for esophageal part of CREST

PPI

treatment for sclerodactyly part of CREST

penicillamine

never give what in renal crisis in scleroderma

steroids!

anticentromere

CREST

antiscl70/topoisomerase

sceleroderma

dry eyes, dry mouth (cavities), parotid swelling

sjogrens

Ro/La

sjogrens (check ANA/RF first)

myosities types

inclusion body - t-cell polymyositis - t-cell dermatomyositis - complex deposition

heliotrope rash gottron's papules shawl sign

myosities

increased CK, EMG positive

myosities - bx will show which one

Anti Mi/Anti Jo

myosities

tx for renal problems in scleroderma

ACE

tx for poly/dermatomyositis

steroids

positive birefringeance with rhomboid shaped crystals

pseudogout

negative birefringeance with needle shaped crystals

gout

use which drugs in gout/pseudogout flare/prophylaxis

cochicine (unless CKD) NSAIDs (unless bleeding) steroids (if the other two are contraindicated)

when is probenicid used

when a person has gout and NO risk factors

prevent tumor lysis

IVF + allopurinol

fix tumor lysis

rasburicase

keep uric acid below what in gout

Septic knee, suspect MSSA vs MRSA

nafcillin vs vanc/linezolid

shock with decreased breath sounds and trach deviation

hemothorax

hyperprolatinemia can also give what s/e in antipsychotics

sexual dys

unilateral cavernous hemangioma on trigeminal nerve and tramline intercranial calcifications with seizures

sturge-weber

depression symptoms within 3 months of a life change (school starts, breakup, move)

adjustment disorder

treatment for adjustment disorder

psychotherapy

diagnose lichen sclerosis

punch bx

treatment for lichen scleorisis

topical corticosteroid - clobestol

pH of BV

5-6.5

thin, loose skin, thin umbilical cord, wide anterior fontanelle, also meconium staining

fetal growth restriction

mouth blisters with large flaccid bullous lesions

pemphigus vulgaris - vulgar flaccid lesions

pemphigus vulgaris - which abs

autoantibodies against desmoglein

tx for polymyalgia rheumatica

steroids - no other diagnostic step is necessary

when is supplemetnal iron needed in an infant

prematurity materal iron def cows milk before 1 year

all exclusively breast fed infants need what supplemented

vitamin D

increased alk phos out of proportion to LFTs

biliary obs or intrahepatic cholestasis

conjugated bili increase + increased alk phos + painless jaundice + weight loss

cholangiocarcinoma or pancreatic carcinoma

hypovolemia (renin and Na)

renin increases and urine sodium decreases becuase the body is trying to hold onto water so it also holds Na

low volume bloody diarrhea with low fever in HIV pt with CD4 ct <5

CMV

microsporidium vs cryptosporidium in HIV

micro - watery diarrhea without fever | crypto - severe watery diarrhea with low fever

treat >1cm or symptomatic prolactinoma with what

dopamine agonists - cabergoline

acyclovir IV can cause what if not pretreated

crystaline nephropathy if not hydrated

decreased LV preload, CO, systemic BP increaed HR CVP and PCWP are decreaesd because of intravascular blood volume

hypovolemic shock

tx for tertiary hyperparathyroidism

remove the parathyroids

labs seen in cushings

hypoK, hypercalciuria, met alk

HLA in hashimotos

HLADR3/5

which imagining helps diagnose primary hyperaldo

adrenal CT

adrenal CT helps distinguish what in primary hyperaldo

Conn (adenoma) and idopathic

are germinal centers normal in thyroid tissue

no, this is graves disease

pale colloid with scalloped edges in the thyroid

graves disease

toxic strains of cholera

01 and 0139

hypotension , salt wasting, and ambiguous female genitalia at birth

21-OH CAH

Hurthle cells are associated with what

Hashimotos thyroiditis

deeply eosinophilic tissue in thyroid

Hurthle cell metaplasia from hashimotos

MC heart problem in cushings

diastolic failure

MC drug used in cushings to treat symptoms

ketoconazole (blocks steroid synthesis)

secondary adrenal insufficiency presents with

profound hypoglycemia and low testosterone

in exogenous thyroid hormone use what will happen to RAUI scan

decreased uptake

nodular lymphatic growth pattern without normal germinal centers

NHL

hyperthyroid treatment in pregnancy

PTU in first trimester, Methimazole thereafter

congenital, extravascular, Coombs-negative hemolytic anemia should also be tested for

pyruvate kinase deficiency

RPGN with anti GBM abs

type 1

RPGN with immune complex abs

type 2

RPGN with no immune complex deposition

type 3

type of RPGN of goodpastures syndrome

type 1

type of RPGN involved in PSGN, lupus nephritis, HSP or IgA nephropathy

type 2

type of RPGN in wegners granulomatosis or microscopic polyangitis

type 3

elevated labs in AIN

eosinophilia and creatinine

what is seen in the CSF of AIDS dementia

B2 microglobulin

pt with rbc casts, increased ESR/CRP and positive C-ANCA

Wegners granulomatosis (granulomatosis with polyangitis)

Pleural fluid protein / serum protein ratio of 0.3, pleural fluid LDH / serum LDH ratio of 0.5, and a pleural fluid LDH of 150 U/L would indicate what etiology in a pt with new onset SOB, and orthopnea

CHF

pt with tremors and confusion, low blood glucose (<50), and is at normal baseline when glucose is normal - triad?

whipples triad

increased insulin with decreased c-peptide

serreptitous hypoglycemia - theyre faking it

Non-suppression of serum insulin levels in the setting of hypoglycemia

insulin secreting tumor

Whipple's triad suggests what etiology of hypoglycemia

insulinoma

if pt cannot have surgical removal of insulinoma - treatment?

diazoxazide

elevated c-peptide in someone with hypoglycemia

sulfonyurea tox or insulinoma

what syndrome are insulinomas assoc with

MEN1

treatment for hypoglycemia from sulfonyurea OD

octreotide

hypopartahytoidism results in what defi

hypocalcemia

hypocalcemia, hyperphosphatemia and low serum PTH

hypoparathyroidism

>6/<1mg mag can impair what hormone

PTH

somatostatin inhibits what

which hormone conserves water

ADH by increasing water reabsorption at the collecting duct

MEN2a and 2b ALWAYS get what

medullary thyroid ca

PTH is secreted in response to

hypocalcemia

what effect does calciton have

tones down the calcium - opposes PTH by inhibiting bone reabsorption

PTH function in the kidneys

increase DCT reabsorption of Ca to increase serum calcium levels increase Vitmain D decrease phosphate reabsorption

stimulates bones to produce RANK-L and G-CSF which causes osteoclast proliferation

PTH

which hormone regulates T4 levels

TBG

which tyroid casues short lived metabolic effects

T3, shorter half life

woman <40 with unpalpable pulses

takayasus

antibodies to desmoglein (desmosomes) and nikolsky + and ruptures easily

pemphigus vulgaris - vulgar, it's life threatning, there's blisters in the mouth and is super gross

bx of blister showing thin walled blister with cells askew and IF throughout the whole slide

pemphigus vulgaris

treatment for vulgaris

steroids

round blisters in older person with -nikosky sign with no mouth lesions

pemphigoid (O for ROUND blisters)

only IF at the bm in blistering disease

pemphigoid

neutrophlic abscess in someone with herpetic like lesion on the buttocks

dermatoformis herpetaformis - celiac

treatment for DH

avoid gluten - dapsone for DH

blisters on someone in sunexposed areas in a hairy person

PCT - diagnose with wood lamp (urine) - look for HepC or recent contraceptive start

rash on the hairy parts ofa persons face

sebbhoreic dermatitsi - tx with selenium shampoo

nail with pits in it

psoriasis

1st line therapy for psoriasis

UV light

CA that is increased in psoriases

lymphoma

purple papule with lacy white network

lichen planus

new medication with purple papule

ACE, thiazides, etc casued lichen planus

drug that causes hyperkalemia from sodium channel blockade in the collecting tubule

trimethoprim

gas showing in the gall bladder

emphysemetous cholecystitis

possible complications of mumps

aseptic meningitis and orchitis

drug that can increase digitoxin levels

amiodarone

heart pt with sudden onset of weakness, fatigue, anorexia, n/v and abdominal pain

digoxin toxicity

abrupt cessation of alprazolam can cause

seizures

where is intussuception most likely to occur in HSP

ileo-ileal Ileo-colic in normal children

difference between ileocolic and ileoileal intussuception

iliocolic can be treated with air enema, ileoileal cannot and requires surgery

Turner's also has what lymphatic abnormality

dysgenesis of the lympahtic system and edema

HIV patient with headaches, papilledema and fever increasing over the last 2 weeks

cryptococcal meningitis

acute unilateral lymphadenitis in children

s aureus followed by GAS

treatment for cocaine associated chest pain

benzos

medication that is contraindicated in acute cocoaine tox

beta blockers

MCC of death after SAH, 24 hours? 5-10 days?

24 hours - rebleeding | 5-10 days - vasospasm leading to CVA (treat with nimodipine)

first step after adnexal mass is found in elderly woman

U/S and CA125 level

torus paletinous

congenital bony growth on hard palatte

chronic cough from increased circulating substance P, kinins, prostoglandins and thromboxane

ACE inhibitors

reason diphenhydramine causes urinary retention

detrusor hypocontracitbility

abs in antiphospholipid syndrome

Lupus anticoagulant, anticardiolipin, and anti-beta-2 glycoprotein

cystic fibrosis involves which chromosome

TMP-SMX prophylaxes for what AIDS defining illneses

Toxo and PCP TMP-SMX - T for Toxo and all the letters TMP, SMX, PCP

someone with rheumatic fever caused mitral stenosis - medical therapy

prophylax with pcn

how does hypophosphatemia results in hypoxemia of the tissue

decreased ATP formation as well as decreased 2,3-diphosphoglycerate, the latter resulting in increased hemoglobin affinity for oxygen and a concomitant decrease in oxygen release in hypoxic tissues

treatment of hypovolemia with acidosis

D5 or lactated ringers with NaHCO3

4 infections at CD <100

JC, bartonella, toxo, aspergillus

treatment for epiglottitis

10 days ceftriaxone

elevated free plasma hemogloin, elevated urine free hemoglobin, urinary hemosiderin

intravascular hemolysis

if pt is hypokalemic how much K should they excrete in a day

<25 if the kidneys are responding properly

what can long term sideroblastic anemia cause

leukemia/myelodysplastic syndrome

DDAVP does what for SIADH and DI

causes SIADH and treats central DI

treatment for DIC pt with tissue thrombosis and necorisis

IV protein C

pt has a dysfunctional PK-LR gene

pyruvate kinase deficiency

normal way the body keeps pH normal

chemical buffering by HCO3- in the ECF and by proteins and phosphate in the ICF

anticoag after HIT - normal renal/liver

argatroban

anticoag after HIT - renal failure

argatroban

anticoag after HIT liver failure

fondiparineax

anticoag after HIT liver failure

fondiparineax

anticoag after HIT liver and renal failure

bivalirduin or argatroban at reduced dose

male pattern hair loss

5-DHT

treatment for male pattern hair losq

minixodil and finasteride

treatment for tinea capitus

oral griseofulvin - if you don't treat quickly you could lose your hair permanently

baby born at 39 weeks with some grunting and hyperextended wet lungs on CT

TTN

baby born at 29 weeks with hypoextended and atelectasis lungs on CT

RDS

tx for RDS

intubation and surfactant

tx for TTN in baby

PPV

compartment syndrome has what underlying pathology

vascular comprimise and not myonecrosis

second generation antipsychotic with the best s/e profile

ziprasidone

rapid onset of periumbicila pain w/nausea vomiting

mesenteric ischemia

thiazides can do what to glucose

increase it especially in DM pts

treatment for hyponatremia

fluid restriction and hypertonic saline

high levels of insulin do what to phosphate

push phosphate into cells

HIV medication type that is highly resistant to resistance

PROTease inhibitiors PROTect from resistance

first sign of hypermag

hyporeflexia

causes of nephrogenic DI

lithium, demeclocycline, hyperCa, hypoK, PCOS, obstructive uropathy

how to make a clincial diagnosis of TTP/HUS

MAHA and thrombocytopenia

kidney stones that are radiolucent

uric acid

treatment for uric acid induced platelet dysfunction and bleeding

estrogen

tx for bleeding from dental extraction

antifibrinolytic agents

insulin deficiency does what to phos

shifts from ICF to ECF, will look like hyperphos

phosphate derangement seen in DKA why

hyperphosphatemia becuase lack of insulin forces phos to move from ICF to ECF

what stimulates intercalated cells in collecting duct

aldosterone

lytic bones lesions - what mets

lung, thyroid, renal

blastic lesions on xray - what mets

breast, prostate

brachial plexus injurty associated with horners

klumpky's (klutzy)

MC injury that leads to ulnar claw hand

medial epicondyle fractures of the humerus

MC location of compartment syndrome

closed tibial fx

ground glass opacities on XR in a premature infant in the NICU for 35 days

BPD from RDS | prevent with surfactant and steroids to mom antenatally

IVH cause

highly vacualr lining of ventricles still around before 34 weeks

bloody bowel movement in premie in the NICU

NEC

how to diagnose imperforate anus

cross table XR

what syndrome should you suspect in imperforate anus

VACTERL | vertebral, anus, cardiac, te fistula, esophageal atresia, renal, limb

failure to innervate distal colon

hirscprungs

bx shows no mesenteric plexus in a 3 year old boy

Hirschprungs

tx for meconium ileus

water enema

mtoher treated with mag for preeclampsia in labor can cause what in the newborn

meconium ileus

first steps after finding an imperforate anus

ECG and pass an NG tube

do what before repairing an imperforate anus

assess for VACTERL

diagnostic steps for hirschprungs

1) KUB 2) contrast enema 3) rectal suction bx 4) resection

first step in meconium ileus after KUB

contrast enema

intestinal atresia cause

mom does some kind of vaoconstrictor like cocaine

double bubble with no gas after vs gas after

annular pancreas, malrotation, DA - normal after | intetinal atresia - multiple air fluid levels

MC type of TE

type E

how to diagnose TE

NG tube that coils in esophagus

3 weeek od male that was feeding and stooling fine but suddenly had non bilious emesis after each meal

pyloric stenosis

5 week old baby with hypocholemic hypokalemic metabolic alkalsosis after projectile vomitning all feedds for the past week - next step

fix electrolyte disturbance then surgery for pyloric stenosis

if a yellow baby has conjugated bili what does that mean

pathologic jaundice

physiologic jaundice with positive coombs

isoimmunization

coombs negative jaundice with low hemoglobin

likely cephalohamtoma

coombs negative jaundice with high hemoglobin

transfusion (twin-twin), materal transfusion

coombs neg jaundice with normal hemoglobin

check reticulocytes, Hemoglobin SS, G6PD, PK

physiologic vs pathologic jaundice

phys - unconjugated/indirect | pathologic - direct/conjugated

jaundice that causes kernicterus in babies

UNconjugated is very UNfortunate for babies brains

suspect what in a baby with high direct bilirubin

obstruction, sepsis, metabolic disorder

sdie you find gastroschisis on

right

worsening jaundice at 2 weeks with hyperbilirubinemia

biliary atresia, give pheno barb for 5 days and then do HIDA scan

quad scrren with increased AFP

spinabifida

double bubble with no gas beyond

duodenal atresia

respiratory acidosis in asthma patient

ominous sign, intubate

dilated loops of bowel with no transition pt in a patient who has not passed gas/BM since surgery 4 days ago

postoperative ileus

next step after clavicle fraxture

angiogram and neurovascualr workup because of proximity to brachial plexus and subclavian artery

hypothyroid pt on levo starts taking oral estrogen, what happens now

increase levo most likely

best way to prevent ARDS damage

lung protective strategies like decreased TV which prevents overdistention of alveoli

pt has suicide attempt, unknown substance, with urinary retention and a fever

diphenhydramine or other anticholinerigc medication

pericardial effusion - what EKG finding

fucking electrical alternans FUCKING ELECTRICAL ALTERNANS

MC type of urinary incontinence in pregnancy

stress incontinence beucase babies stress you out

watery diarrhea, hypokalemia, hypercalcemia, flushing, muscle cramps, weakness

check a VIP level this is a VIPoma

white nodules on hands or feet

gout

pagets disease's other name

osteitis deformans

non genetic basis for pagets disease

paramyxovirus or respiratory syncytial virus

complications of pagets disease

secondary osteosarcoma, fibrosarcoma, or chondrosarcoma

nonosteo s/e of pagets

high output cardiac failure due to the increased vascularity

elevated levels of what in of pagets

elevated serum alkaline phosphatase and urine hydroxyproline (a marker of collagen breakdown)

imaging for pagets

bone scan will pick up hot lytic lesions

what size vasculitis is polyarteritis nodosa

medium

co-occuring diseases in PAN

hepB, hepC, hair cell leukemia

vasculitis which spares the lungs

PAN

other vasulitis with palpable purpura that is not HSP

PAN

you suspect PAN and get a +ANCA

it's not PAN - only vasculitis w/o ANCA

only vasculitis without ANCA+

PAN

vasculitidi that is most associated with abdominal paina nd post prandial abdominal ischemia

PAN

non-biopsy diagnosis for PAN

arteriography showing strictures

part of muscle affected in dermatomyositis

perimysial and perifascicular inflammation and atrophy

part of muscle affected in polymyositis

endomysial inflammation; the necrotic and regenerating muscle fibers are scattered throughout the fascicle and not limited to the fascicle periphery

short-duration, low-amplitude, polyphasic motor potentials on EMG

myosities

chondrocaldcinosis - gout vs pseudogout

pseudogout

MC afflicted in pseudogout

knee and wrist

Egg allergy, which vax can't you have

yellow fever

what do you give for diptheria

IVtoxin and IV abx

treatment for pertussis

erythromycin

ARDS is associated with

decreased lung compliance, alveolar infiltrates, hypoxemia and PAH

esosinophilia (>20%) in someon ewith recent travel to south america

trichinellosis

what distinguishes peritonsilar abscess from epiglottitis

deviation of the uvula and unilateral lymphadenopathy in PA

treatment difference for Type A vs B aortic dissection

type A - Angiography | type B - Beta blocker

medical treatment of HOCM

beta blocker, disopyramide and verapamil

testosterone secreting tumor

leydig

inhibiton of LH and FSH in a testicualr tumor

leydig

MC congential cardiac cyanosis in newborn

transposition of the great vessels

cyanosis in a few hour old infant with single second heart sound

transposition of the great vessles

what happens to ca during respiratory alk

more ca ninds to albumin and thus leads to hypocalcemia

methylmalonic vs homocysteine in folic acid vs B12 def

When folic acid or B12 are absent there are increased level of serum homocysteine. However, only B12 is involved in the conversion of methylmalonic acid to succinyl CoA. Therefore, in folate deficiency methylmalonic acid levels are normal

measles is caused by

parvomyxovirus

measles rash

fever and a rash, starts on face, works its way down

cough, coryza, koplik spots

measles

rash on the face that spreads to the trunk with generalized and tender lymphadenopathy

rubella

rash on the face with fever - one kid has white spots in the mouth and one has tender lymphadenopthay

spots - measles | lymph - rubella

high fever then rash in a chidl with rash on the trunk that moves to the face

roseola

treat a really high fever n baby

acetaminophen

vesicular rash in different stages of healing without fever in a child

chicken pox

treatment for chicken pox

none - supporttive

vesciles on the hands, feet, mouth

hands foot mouth disease

rubeola is also known as

measles

pt has impaired calcification - what to give

clcium

someone with angioedema and they have C1 esterase def what to give

FFP

croup is caused by

parainfluenza virus

diagnosis for croup

racemic epi

croup that doesn't react to reacemic epi

bacterial tracheitis

pat of epiglottitis

h flu

rapid onset of high spiking fever with drooling and hot potato voice that looks very toxic

epiglottitis

thumb print sign

epiglottitis

difference between epiglottitis and retropharyngela abscess

both have high fevre, quick onset with hot potato voice with neck extended RPA - unilear anterior chain lymphadenopathy - get CT scan

difference between retropharyngeal abscess and peritonsilar abscess

PA - older child/adolescent with drooling, hot potato voice with uvular deviation

path of peritonsilar abscess

oral flora

gait ataxia, frequent falling, and dysarthria in a 17 year old male

freidrich's ataxia

MCC of death in FA

cardiomyopathy

19 year old male patient is progressively having more difficulty walking, has odd looking feet, and large heart on XR

freidrichs ataxia

new onset psychosis after a new drug added - whats the drug

glucocorticoids

MCC of urogenital fistula

pelvic surgery

only reason to use hormone replacement therapy in postmenopausal woman

vasomotor symptoms

abrupt onset of CVA symptoms

cranial bleed

MC locations of intercranial bleeds

BG, thalamus, pons, cerebellum

vitamin def associated with diarrhea, skin rash, beefy red tongue, cognitive problems

niacin

adrenal insufficiency secondary to glucocorticoid cessation - hormone levels

low ACTH, low cortisol, normal aldosterone

hormone and electrolyte derangements in primary adrenal insifficiency

elevated ACTH, low aldosterone, hypoNa, hyperK

diagnostic test for Zenkers

contrast esopagram

best treatment for cachexia in terminally ill patient

progesterone analog and/or corticosteroids

how do nitrates work to reduce anginal symptoms

systemic vasodilation which leads to lower LVEDV and preload and reduces wall stress

primary prevention for statin therapy

10 year ASCVD of >7.5%

failure to thrive in infancy with chronic non-gap metabolic acidosis

Renal tubular acidosis - tx with bicarb