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Residency > Step3 UWorld > Flashcards

Step3 UWorld Flashcards

1
Q

Absolute contraindications for OCPs

A 
Migraine with aura
>35 yo + >15 cigarettes per day
H/o VTE or CVA
BP> 160/100
DM with end organ damage
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2
Q

Management of lupus nephritis

A

Initial: urgent renal biopsy prior to treatment
Therapy is guided by disease classification
Classes I, II: no therapy indicated
Classes III, IV: immunosuppression (glucocorticoids and cyclophos or cellcept)
Class V: may need immunosuppression if proliferative lesions or nephrotic syndrome
Class VI: advanced sclerosis, no immunosuppression

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3
Q

Management of gout. Acute? Chronic? If renal failure?

A

Acute: Colchicine and Indomethacine
Acute + renal failure: intra-articular steroids
Acute + renal failure + multiple joints: prednisone
Chronic: Allopurinol

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4
Q

Presentation of basilar artery occlusion

A

Ataxia, incoordination, motor weakness, AMS, facial weakness, dysphagia/dysarthria, gaze paralysis

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5
Q

Mycotic aneurysm
cause?
presentation?

A

Due to localized vessel wall destruction as a complication of infective endocarditis

Presentation: expanding mass with focal neurological findings or with aneurysm rupture and subarachnoid hemorrhage (HA, lethargy, neck stiffness)

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6
Q

Midsystolic (non-ejection) click followed by systolic murmur that increases with Valsalva
What’s the murmur?

A

Mitral valve prolapse

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7
Q

Ejection click followed by harsh systolic crescendo-decresendo murmur, radiates to the carotids, decreases with Valsalva
What’s the murmur?

A

Aortic stenosis

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8
Q

Infant of diabetic mother: first trimester complications

A 
Congenital heart disease
Hypoplastic left heart sydrome
Neural tube defects
Small left colon syndrome
Polycythemia 
Organomegaly
Spontaneous abortion
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9
Q

Infant of diabetic mother: second/third trimester complications

A

Hypertrophic cardiomyopathy
Shoulder dystocia
Macrosomia
Fetal hyperglycemia + hyperinsulinemia

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10
Q

Diastolic low-pitched murmur with opening snap, best heard at apex
What’s the murmur?

A

Mitral valve stenosis

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11
Q

How do you calculate the sensitivity of a test? What does it refer to?

A

Sensitivity: ability of a test to correctly identify individuals with a disease. More true positives, fewer false negatives
Sens = TP/(TP+FN)

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12
Q

How do you calculate the specificity of a test? What does it refer to?

A

Specificity: ability of a test to correctly identify individuals who are WITHOUT disease. More true negatives, fewer false positives
Spec = TN/(TN+FP)

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13
Q

Patient with multiple myeloma presents with nasal/oral bleeding, confusion, HA, dizziness, vertigo, nystagmus, hearing loss and visual impairment. Likely diagnosis? And treatment?

A

Dx: Hyperviscosity syndrome
Tx: Plasmapheresis

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14
Q

Complications of multiple myeloma?

A 
Hypercalcemia
Renal insufficiency
Infections
Skeletal lesions -> pathologic fractures
Hyperviscosity syndrome
Thrombosis
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15
Q

Choice of antihypertensive in patient with history of gout?

A

ARB!

Avoid thiazides, loop diuretics and ASA

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16
Q

Treatment for tinea pedis

A

Mild: topical antifungals (terbinafine, miconazole, clomitrazole)
Mod/severe (or with nail involvement): oral antifungals (terbinafine, itraconazole, fluconazole)

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17
Q

The use of erythromycin and azithromycin early in infancy is associated with increased risk of developing…?

A

Pyloric stenosis

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18
Q

Screening for gestational diabetes?

A

at 24-28 weeks gestation, first do 1hr 50g glucose challenge, if >140BS, then do 3hr 100g glucose tolerance. Positive if 2 of 3 BS levels are elevated.

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19
Q

Presentation: intermittent episodes of abrupt-onset palpitations and a sensation of a racing heartbeat.
EKG: narrow-complex tachycardia with regular R-R intervals and often retrograde p waves
Diagnosis?

A

Paroxysmal supraventricular tachycardia

20
Q

EKG: short PR, delta at beginning of QRS, wide QRS

Diagnosis?

A

Wolff-Parkinson-White, associated with development of AVRT. Increased risk of symptomatic paroxysmal SVT

21
Q

Management of MI due to cocaine intoxication

A

Benzos and nitro (BB are contraindicated)
CCBs for persistent chest pain
Phentolamine for persistent HTN
PCI for MI

22
Q

Toxicities associated with Trastuzumab?

A

Cardiomyopathy, usually reversible with discontinuation

Pulmonary toxicity

23
Q

ACS medical management

A 
Dual antiplatelet meds: ASA, plavix/platelet P2Y12 receptor blocker
Nitrates
Beta Blocker
Statin
AC (heparin, etc.)
24
Q

Indications for cardiac re-synchronization with biventricular pacing

A

LV EF <35%
NYHA class II-IV (presence of ANY Sx)
LBBB with QRS >150msec

25
Q

Treatment for group 1 (idiopathic) pulmonary hypertension

A

Dual therapy: Endothelin receptor antagonist (bosentan, ambrisentan) + phosphodiesterase 5 inhibitor (tadalafil, sildenafil)

26
Q

Characteristics of pain associated with lumbar spinal stenosis

A

Disappears/decreases when sitting down
Increases with spine extension
Decreases with spine flexion

27
Q

murmur of VSD?

A

harsh holosystolic at left 3rd/4th intercostal space, often with palpable thrill

28
Q

work-up for suspected marfan’s for sports physical clearance?

A

Echo - r/o aortic root disease

29
Q

Antibiotics for uncomplicated cystitis in pregnancy?

A

Nitrofurantoin
Cephalexin
Fosfomycin
Amox-clauv

NO BACTRIM -> NT defects
No tetracyclines, no flouroquinolones

30
Q

Antibiotics for pyelo in pregnancy?

A

Ceftriaxone or cefepime until afebrile >48hrs, then switch to oral for 10-14 d

31
Q

How to confirm diagnosis of sarcoid?

A

Excisional lymph node biopsy -> see noncaseating granulomas

And rule-out other etiologies (e.g. TB)

32
Q

Multifocal atrial tachycardia:
Often secondary to?
EKG findings?

A

Often secondary to: acute exacerbation of underlying pulmonary disease, right atrial enlargement, catecholamine surge (as in sepsis), electrolyte imbalance
EKG findings? P waves of at least 3 different morphologies, irregular R-R intervals, atrial rate >100

33
Q

Palpable purpura in gravity-dependent areas, abdominal pain, arthralgias in child?

A

HSP
+ IgA nephropathy, later finding
abdominal pain from small bowel intussusception

34
Q

Calcium and phosphate derangements in CKD?

A

1) decreased filtered phosphate -> phosphate retention, binds Ca, lowers free Ca, rise in PTH
2) decreased conversion to 1,25-vitamin D -> decreased intestinal Ca absorption
3) Secondary hyperparathyroidism due to above
4) can lead to autonomous PTH secretion (tertiary hyperparathyroidism) unresponsive to rising Ca -> bone pain, high alk phos -> needs parathyroidectomy

35
Q

Adverse effects of amiodarone?

A 
Pulmonary toxicity
Photosensitivity
Skin discoloration
Thyroid dysfunction
Bone marrow suppression
Abnormal LFTs
36
Q

Most common bug in erysipelas?

A

Group A strep

37
Q

Conditions associated with high SAAG?

With low SAAG?

A

SAAG = serum albumin - ascites albumin
High (>1.1) = CHF, hepatic cirrhosis, alcoholic hepatitis
Low (<1.1) = peritoneal carcinomatosis, peritoneal TB, nephrotic syndrome, pancreatitis, serositis

38
Q

Early signs of CP?

Work-up recommended?

A

Delayed disappearance of neonatal reflexes, persistent or asymmetric fisting, hypertonia/spasticity, hyperreflexia, sustained clonus, delayed motor milestones
Recommend MRI brain

39
Q

Cat scratch disease: presentation and treatment?

A

Presentation: cutaneous lesion and regional LAD following cat scratch.
Tx: Azithromycin

40
Q

Treatment of scleroderma renal crisis?

A

ACE i (captopril, due to rapid onset) +/- IV nitroprusside if in HTN emergency

41
Q

Treatment of B12 in patients with severe megaloblastic anemia can cause what metabolic derangement?

A

Hypokalemia, especially within the first 48 hours

42
Q

Abx choice for human and mammal bites?

A

Amox/clauv or ampicillin/sulbactam (if IV needed)

43
Q

Mitral stenosis:
characteristic murmur?
clinical presentation?

A

Murmur: loud first heart sound and mid-diastolic rumble
Presentation: DOE, orthopnea, PND

44
Q

Tx for hemodynamically significany bradycardia?

A

IV atropine

45
Q

Screening test for Cushing’s?

When to suspect?

A

Dexamethasone suppression test or 24hr urinary free cortisol

Suspect in: hypertension, hyperglycemia, osteoporosis, mood swings, hypokalemia, metabolic alkalosis

46
Q

Tx for ITP?

A

If platelets >30k and no bleeding, ok to observe

If platelets <30k or if bleeding: corticosteroids

47
Q

Symptoms of digoxin toxicity?

A

nausea, vomiting, anorexia, fatigue, confusion, visual disturbances, cardiac abnormalities.

Can be precipitated by: verapamil, quinidine, amiodarone

Residency (3 decks)

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