USMLE Flashcards
1
Q
clinical presentation and Ba swallow suggest achalasia.. what next?
A
endoscopy to r/o esophageal cancer
2
Q
hordeolum is what?
A
a stye, usually caused by staph aureus
3
Q
brain tumor with CT/MRI butterfly appearance
heterogenous and serpiginous contrast enhancement
A
GBM
4
Q
target cells usually seen with what?
A
thalassemia, not so much iron deficiency anemia
5
Q
what to do if you suspect toxic megacolon?
A
abd xray to confirm dx
6
Q
how to tx toxic megacolon
A
conservative management: NPO, NG, steroids (if caused by IBD) or abx (if caused by infection)
-if that doesn’t work, then emergency surgery
7
Q
patient with jaundice should be worked up with what dx test first?
A
US
8
Q
recurrent bouts of upper abd pain, diarrhea/steatorrhea, weight loss
A
chronic pancreatitis
9
Q
how to dx chronic pancreatitis
A
CT scan
amylase and lipase may be normal
10
Q
if you suspect pancreatic cancer, what study should you get?
A
CT scan
11
Q
arthralgias, weight loss, fever, diarrhea, abdominal pain, chronic cough, cardiac and valvular problems, pigmentation, lymphadenopathy
PAS positive stuff in lamina propria of small intestine
A
whipple’s disease
12
Q
you are likely to form cholesterol gallstones during ______
A
pregnancy
effects of estrogen and progesterone
13
Q
most common cause of iron deficiency anemia in old ppl is _________. what do you do next?
A
GI blood loss
perform colonoscopy. if negative, then EGD
14
Q
asymptomatic diverticulosis is tx with what
A
increased fiber in the diet
15
Q
- back pain, anemia, renal dysfunction, elevated ESR
- constipation, weakness, renal tubular problems, neurologic sxs, anorexia
A
multiple myeloma causing hypercalcemia
16
Q
always look for __________ as a cause of constipation
A
hypercalcemia
17
Q
old patients with new onset dyspepsia
young patients with new onset dyspepsia and weight loss/vomiting/dysphagia
what to do?
A
upper endoscopy
18
Q
young pts with new onset dyspepsia and w/o alarm sxs. what to do? (2)
A
PPI trial
H Pylori testing
19
Q
- old person with tea and toast diet is deficient in what
- macrocytic anemia
A
folic acid
20
Q
vegans often deficient in what
anemia + CNS problems
A
vitamin B12
21
Q
perifollicular hemorrhage, swollen gums, poor wound healing
A
scurvy (vitamin c deficiency)
22
Q
osteomalacia and hypocalcemic tetany in adults caused by ______ deficiency
A
vitamin D
23
Q
RBC fragility, hyporeflexia, muscle weakness, blindness caused by ______ deficiency
A
vitamin E
24
Q
crypt abscesses are characteristic of ___________
A
ulcerative colitis
25
causes of bloody diarrhea
E Coli
Shigella
Campylobacter
26
explain the D-xylose test
normal: D-xylose is absorbed in the proximal small intestine and excreted in the urine
small intestine disease: D-xylose is not absorbed and instead, excreted via the feces
27
elevated BUN/Cr ratio means what (3 things)
- prerenal renal failure
- GI bleeding (due to reabsorption of blood from GI tract)
- steroid administration
28
first indicator of hypovolemia
pulse rate
29
post-prandial abdominal cramps, weakness, light-headedness, diaphoresis after having a partial gastrectomy
early dumping syndrome
30
how to tx early dumping syndrome
dietary modification
octreotide
reconstructive surgery
31
rectangular enveloped shaped crystals in urine
ca oxalate crystals
| often due to ethylene glycol poisoning
32
how to calculated serum osmolarity
2*Na + glucose/18 + BUN/2.8
33
elevated osmolar gap metabolic acidosis indicates (3 things)
methanol, ethanol, or ethylene glycol poisoning
34
hypokalemia, hyponatremia with increased urinary Na and K
diuretic abuse
35
main causes of metabolic alkalosis
- administration of alkali
- removal of acidic gastric secretions via vomiting and NG tube
- renal H+ loss due to mineralocorticoid excess
- contraction alkalosis
36
in pts requiring multiple transfusions during surgery, they are at risk for _________
-hyperactive DTRs, muscle cramps, rarely convulsions
hypocalcemia
37
muscle weakness, cramps, flaccid paralysis, U waves on EKG
hypokalemia
38
muscle weakness, flaccid paralysis, peaked T waves, asystole
hyperkalemia
39
decreased DTRs, muscle paralysis, apnea, cardiac arrest
hypermagnesemia
40
causes of nephrogenic DI
hypercalcemia
severe hypokalemia
tubulointerstitial renal disease
meds: Li, amphotericin, cidofovir
41
common meds that cause hyperkalemia
```
nonselective beta blockers
K sparing diuretics (ex. triamterene, trimethoprim)
ACEIs
ARBs
NSAIDs
digoxin
cyclosporin
heparin
succinylcholine
```
42
glucose range for DKA
250-600
43
how to shift K from extracellular to intracellular
insulin and glucose
Na bicarb
albuterol (beta 2 agonist)
44
when not to use succinylcholine
when risk for hyperkalemia
- crush injuries
- demyelinating syndromes
- tumor lysis syndromes
45
potential side effects of loop diuretics
hypokalemia
metabolic alkalosis
prerenal renal failure
46
2 classes of metabolic alkalosis
1. chloride sensitive (hypochloremic, saline responsive)
- urinary Cl < 20
- ECF volume depletion --> mineralocorticoid --> bicarb retention, H+ loss, K+ loss
- causes: thiazide/loop diuretics, vomiting/NG suction
- tx with volume repletion via saline
2. chloride resistant (normochloremic, saline unresponsive)
- urinary Cl > 20
- ECF volume expansion
- causes: primary hyperaldosteronism, Bartter's, Gitelman's, licorice ingestion
- not corrected by saline infusion
47
COPDers with chronic respiratory acidosis treated with diuretics are at risk for ______
prerenal renal failure due to drop in cardiac output
48
anorexia, fatigue, GI complaints, weight loss, hypotension, hyponatremia, hyperkalemia, hyper pigmentation or vitiligo, anemia, eosinophilia
Addison's (adrenal insufficiency)
| -causes: autoimmune, TB, HIV, fungi, metastatic cancer, hemorrhagic infarction
49
acute symptomatic hyponatremia: correct with ________ at no more than _______
3% saline
| 0.5 mEq/L/hr
50
pt with h/o GERD now has difficulty swallowing solids. endoscopy shows symmetric circumferential narrowing
peptic stricture
51
tissue transglutaminase antibodies are diagnostic of what?
celiac disease
52
mono-like syndrome consisting of fever, night sweats, LAD, arthralgias, and diarrhea should make you suspicious for ____
HIV
53
what is cryoprecipitate used for?
to treat patients with fibrinogen, vWF, or factor VIII deficiency
54
pRBC transfusion threshold
hgb < 7 for pts who are otherwise stable
| hgb < 9 for unstable pts related to anemia or ACS with active ischemia
55
______ = dietary deficiency of niacin
often found in ppl with a ___-based diet in Asia
what are the 3 D's?
pellagra
corn
3 Ds- diarrhea, dermatitis, dementia
56
SLE can cause diarrhea (t/f)
F
57
UC extra-intestinal manifestations include:
uveitis
arthritis
erythema nodosum
pyoderma gangrenosum
58
worsening post-prandial pain that leads to avoidance of food is usually suggestive of _____
abdominal angina (atherosclerosis of the mesenteric arteries)
59
IBS can lead to weight loss (t/f)
F
60
- diarrhea
| - modified acid fast stain showing oocysts in stool is highly suggestive of ____________
cryptosporidium parvum
- self limited in immunocompetent
- persistent clinical course in immunocompromised
61
corkscrew esophagus on esophagogram
high amplitude esophageal contractions on manometry
chest pain and dysphagia
diffuse esophageal spasm
| -tx with antispasmodics, dietary changes, psychiatric counseling
62
esophageal smooth muscle atrophy (loss of distal esophageal peristalsis) and incompetent LES
scleroderma
63
foot gets stuck in throat… male with halitosis and regurgitation but no pain
zenker's diverticulum
64
absent peristalsis and super tight LES tone
achalasia
65
- alopecia, abnormal taste, bullous pustulous lesions surrounding body orifices and/or extremities, impaired wound healing
- IBD patient on TPN
zinc deficiency
66
selenium deficiency highly associated with _________
| also not in TPN
cardiomyopathy
67
triad of carcinoid syndrome
flushing
valvular heart disease
diarrhea
68
patients with carcinoid syndrome are at risk for ____ deficiency
niacin
69
________ decreases the renal clearance of digoxin, causing ________ issues
```
verapamil
GI issues (anorexia, N/V)
```
70
multiple duodenal ulcers and a jejunal ulcer are almost pathognomonic for _______
ZES
71
elevated transferrin saturation and ferritin levels suggest _____
bronze diabetes, fatigue, elevated hepatic enzymes
- iron overload
| - maybe due to hereditary hemochromatosis (increased Fe absorption), which causes liver cirrhosis and eventually HCC
72
suspect ________ in a patient with cirrhosis and ascites presenting with fever or altered mental status
to to dx and tx?
SBP
- dx with paracentesis (positive culture or PMN > 250)
- tx with abx
73
what to do if someone comes in with a classic presentation of appendicitis?
immediate surgery
74
when should you image before surgery in suspected appendicitis?
- pregnant women should get ultrasound
- suspected appendicitis with atypical presentation should get US or CT
- pts with symptoms > 5 days should be managed conservatively with IV abx, bowel rest, and delayed appendectomy
75
_______ most common cause of LGIB in elderly
diverticulosis
76
_______ most common solid organ to be injured in blunt abd trauma
spleen
77
how to approach acalculous cholecystitis (usually occurs in very sick patients)
US shows gallbladder distention, thickening of gallbladder wall, pericholecystic fluid
-tx with percutaneous cholecystostomy followed by cholecystectomy when the patient's medical condition improves
78
undifferentiated carcinoma of SCC origin seen in the nose of Mediterranean or Far East ppl
nasopharyngeal carcinoma
79
what is nasopharyngeal carcinoma highly assoc with?
EBV infection
80
how to tx duodenal hematoma
NG suction and parenteral nutrition
| it will resorb spontaneously over time
81
opening snap assoc with what heart issue?
mitral stenosis
82
eggshell calcification of a liver cyst
most likely hydatid cyst
83
how to tx hydatid cyst
not aspiration due to risk of anaphylaxis
| tc: surgically resect with albendazole
84
cysticercosis
cysts in the brain or muscle
| taenia solium
85
management of blunt abdominal trauma in hemo unstable pts
FAST
- positive --> exlap
- inconclusive --> DPL
- negative --> look for other areas of hemorrhage and stabilize --> then get a CT
86
recurrent pneumonia in the same area of the lung should make you suspect ________. Therefore, get a ____
- cancer or some sort of obstruction
| - CT
87
proteinuria, easy bruisability, restrictive cardiomyopathy (thickened ventricular wall, normal ventricular dimensions, slightly reduced systolic function)
amyloidosis
88
capillary pulsations in fingers and lips may be assoc with ____
aortic regurgitation
89
parathyroid adenoma
pituitary tumors
enterohepatic tumors (pancreatic islet cell tumor)
MEN I
90
medullary thyroid cancer
pheochromocytoma
parathyroid hyperplasia
MEN IIA
91
medullary thyroid cancer
pheochromocytoma
other: mucosal and intestinal neuroma, marfanoid habitus
MEN IIB
92
exudative pleural fluid
Light's criteria
- fluid protein/serum protein > 0.5
- fluid LDH/serum LDH > 0.6
- pleural LDH > 2/3 the upper limits of normal serum LDH
93
dementia pts are at risk for pneumonia due to ______
impaired epiglottic function
94
lots of blood on U/A but not many RBCs on urine microscopy...
suspect myoglobinuria, which is often caused by rhabdo, which frequently leads to acute renal failure
95
murmur increases in intensity during valsalva
most likely HOCM
96
what to do with solitary pulmonary nodule…
```
low risk: serial CT scans
medium risk:
-if small --> serial CT
-if large --> PET followed by either serial CT or surgery
high risk: surgical excision
```
97
```
positive breath hydrogen
positive stool for reducing substances
low stool pH
increased stool osmotic gap
NO steatorrhea
```
lactose intolerance
98
what does S4 mean?
stiff LV due to restrictive cardiomyopathy or LVH from longstanding HTN
99
mid systolic click and late systolic murmur over cardiac apex
mitral valve prolapse
100
cor pulmonale is often caused by ______
| you see JVD, right sided S3, RV heave, hepatomegaly, ascites, dependent edema, but NOT pulmonary congestion
COPD
101
chronic malabsorption can cause vitamin D deficiency which presents as:
_____ Ca
_____ phosphate
_____ PTH
low
low
high
102
________ is a potential complication of bronchiectasis
hemoptysis
| NOT malignancy, LV failure, ptx, or PE
103
how to approach esophageal perforation
water soluble contrast esophagography
| tx with abx, parenteral nutrition, surgical repair
104
suspicion for psoas abscess. what next?
- get a CT
- if clinical suspicion is high but CT is negative, you can do a laparoscopy
- tx with percutaneous drainage and abx
105
runners with pain between 3rd and 4th toes reproducible with palpation, clicking sensation when squeezing the metatarsal joints
morton neuroma
| -tx with bilateral shoe inserts
106
fx of bone around the ankle
| burning, numbness, aching of the distal plantar surface of the foot or toes that sometimes radiates up the calf
tarsal tunnel syndrome
107
female who exercises a lot and doesn't weigh very much
| sharp and localized pain over a bony surface that is worse with palpation
stress fracture
108
needle shaped crystals on U/A indicate ______
uric acid stones (radiolucent)
109
ureteral colic can cause ileus (t/f)
yep
110
enteroclysis
used to dx small bowel tumors and other pathology
111
RQ ratios for:
carbohydrates
protein
lipid
1
0. 8
0. 7
112
how to dx breast mass
under 30
- ultrasound
- -> simple cyst- needle aspiration if patient desired
- -> complex cyst/mass- image guided core biopsy
over 30
- mammogram and ultrasound
- -> suspicious for malignancy --> core biopsy
113
fat malasorption can cause _______ oxalate absorption
| this causes ______
increased
| kidney stones
114
if you suspect boerhaave, you should get _____ to dx it for sure
gastrograffin swallow
115
how to tx stress fracture of metatarsal
rest and analgesics
116
someone has symptoms of claudication.. what's the first test?
ABI
117
how to dx kidney stones
noncontrast CT
118
hemo unstable blunt abdominal trauma... after fluid resuscitation, what do you do?
FAST before possible exlap
119
if you see a carotid artery intimal flap, what do you do?
surgical repair
120
palpable breast mass in pts over 35... what's the first test?
mammogram
121
unstable pt with blunt abdominal and pelvic trauma... FAST and DPL are negative... what do you do next?
pelvic angiography
122
how to dx and tx developmental dysplasia of the hips
if < 4 months, dx with US (after physical exam of course)
| tx with spica cast or hip harness
123
trauma patient with nosebleed, what do you get before getting a head CT?
spine xray
| OR you could get head and cspine CT
124
SBO with lactic acidosis, what do you do next?
laparotomy
125
penis fx... what to do?
RUG then surgery
126
how to tx femoral neck fxs?
in young ppl- ORIF
| in old ppl- primary arthroplasty
127
tetanus: <3 doses and clean
toxoid
128
tetanus: at least 3 doses, clean
toxoid only if last dose was > 10 years ago
129
tetanus: <3 doses, dirty wound
toxoid and immunoglobulin
130
tetanus: at least 3 doses, dirty wound
toxoid if > 5 years since last dose
131
how to tx closed femoral shaft tx
closed intramedullary fixation
132
how to approach airway of an apneic pt with head injury
orotracheal intubation or cricothyroidectomy
133
how to tx pancreatic pseudocyst?
| what if there's an infection?
- observe for 4-6 weeks and drain if it doesn't resolve
| - if it's infected, drain immediately
134
O2 and CO2 of the following:
- PE and atelectasis
- asthma/COPD and hypoventilation
- hypoxia, hypocapnea
| - hypoxia, hypercapnea
135
what abx for perforated appendix? (gram - and anaerobes)
cefotetan
136
teen with knee pain, no systemic sxs, sunburst radiology pattern, increased ALP
osteosarcoma
137
blue cells, fever, weight loss, onion skin in diaphyses of long bones/spine/pelvis
Ewing's
138
adults with knee problems and soap bubble appearance on xray
osteoclastoma
139
after cardiac surgery.... fever, leukocytosis, tachycardia, chest pain but NO widened mediastinum
-tx?
postcardiotomy syndrome
| -tx: pericardial puncture if tamponade, aspirin or steroids
140
how to tx acute mediastinitis and what does it often look like on CXR
widened mediastinum
| tx wit drain, debride, abx
