USMLE Flashcards
clinical presentation and Ba swallow suggest achalasia.. what next?
endoscopy to r/o esophageal cancer
hordeolum is what?
a stye, usually caused by staph aureus
brain tumor with CT/MRI butterfly appearance
heterogenous and serpiginous contrast enhancement
GBM
target cells usually seen with what?
thalassemia, not so much iron deficiency anemia
what to do if you suspect toxic megacolon?
abd xray to confirm dx
how to tx toxic megacolon
conservative management: NPO, NG, steroids (if caused by IBD) or abx (if caused by infection)
-if that doesn’t work, then emergency surgery
patient with jaundice should be worked up with what dx test first?
US
recurrent bouts of upper abd pain, diarrhea/steatorrhea, weight loss
chronic pancreatitis
how to dx chronic pancreatitis
CT scan
amylase and lipase may be normal
if you suspect pancreatic cancer, what study should you get?
CT scan
arthralgias, weight loss, fever, diarrhea, abdominal pain, chronic cough, cardiac and valvular problems, pigmentation, lymphadenopathy
PAS positive stuff in lamina propria of small intestine
whipple’s disease
you are likely to form cholesterol gallstones during ______
pregnancy
effects of estrogen and progesterone
most common cause of iron deficiency anemia in old ppl is _________. what do you do next?
GI blood loss
perform colonoscopy. if negative, then EGD
asymptomatic diverticulosis is tx with what
increased fiber in the diet
- back pain, anemia, renal dysfunction, elevated ESR
- constipation, weakness, renal tubular problems, neurologic sxs, anorexia
multiple myeloma causing hypercalcemia
always look for __________ as a cause of constipation
hypercalcemia
old patients with new onset dyspepsia
young patients with new onset dyspepsia and weight loss/vomiting/dysphagia
what to do?
upper endoscopy
young pts with new onset dyspepsia and w/o alarm sxs. what to do? (2)
PPI trial
H Pylori testing
- old person with tea and toast diet is deficient in what
- macrocytic anemia
folic acid
vegans often deficient in what
anemia + CNS problems
vitamin B12
perifollicular hemorrhage, swollen gums, poor wound healing
scurvy (vitamin c deficiency)
osteomalacia and hypocalcemic tetany in adults caused by ______ deficiency
vitamin D
RBC fragility, hyporeflexia, muscle weakness, blindness caused by ______ deficiency
vitamin E
crypt abscesses are characteristic of ___________
ulcerative colitis
causes of bloody diarrhea
E Coli
Shigella
Campylobacter
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
elevated BUN/Cr ratio means what (3 things)
- prerenal renal failure
- GI bleeding (due to reabsorption of blood from GI tract)
- steroid administration
first indicator of hypovolemia
pulse rate
post-prandial abdominal cramps, weakness, light-headedness, diaphoresis after having a partial gastrectomy
early dumping syndrome
how to tx early dumping syndrome
dietary modification
octreotide
reconstructive surgery
rectangular enveloped shaped crystals in urine
ca oxalate crystals
often due to ethylene glycol poisoning
how to calculated serum osmolarity
2*Na + glucose/18 + BUN/2.8
elevated osmolar gap metabolic acidosis indicates (3 things)
methanol, ethanol, or ethylene glycol poisoning
hypokalemia, hyponatremia with increased urinary Na and K
diuretic abuse
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
in pts requiring multiple transfusions during surgery, they are at risk for _________
-hyperactive DTRs, muscle cramps, rarely convulsions
hypocalcemia
muscle weakness, cramps, flaccid paralysis, U waves on EKG
hypokalemia
muscle weakness, flaccid paralysis, peaked T waves, asystole
hyperkalemia
decreased DTRs, muscle paralysis, apnea, cardiac arrest
hypermagnesemia
causes of nephrogenic DI
hypercalcemia
severe hypokalemia
tubulointerstitial renal disease
meds: Li, amphotericin, cidofovir
common meds that cause hyperkalemia
nonselective beta blockers K sparing diuretics (ex. triamterene, trimethoprim) ACEIs ARBs NSAIDs digoxin cyclosporin heparin succinylcholine
glucose range for DKA
250-600
how to shift K from extracellular to intracellular
insulin and glucose
Na bicarb
albuterol (beta 2 agonist)
when not to use succinylcholine
when risk for hyperkalemia
- crush injuries
- demyelinating syndromes
- tumor lysis syndromes
potential side effects of loop diuretics
hypokalemia
metabolic alkalosis
prerenal renal failure
2 classes of metabolic alkalosis
- 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 - 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
COPDers with chronic respiratory acidosis treated with diuretics are at risk for ______
prerenal renal failure due to drop in cardiac output
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
acute symptomatic hyponatremia: correct with ________ at no more than _______
3% saline
0.5 mEq/L/hr
pt with h/o GERD now has difficulty swallowing solids. endoscopy shows symmetric circumferential narrowing
peptic stricture
tissue transglutaminase antibodies are diagnostic of what?
celiac disease
mono-like syndrome consisting of fever, night sweats, LAD, arthralgias, and diarrhea should make you suspicious for ____
HIV
what is cryoprecipitate used for?
to treat patients with fibrinogen, vWF, or factor VIII deficiency
pRBC transfusion threshold
hgb < 7 for pts who are otherwise stable
hgb < 9 for unstable pts related to anemia or ACS with active ischemia
______ = 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
SLE can cause diarrhea (t/f)
F
UC extra-intestinal manifestations include:
uveitis
arthritis
erythema nodosum
pyoderma gangrenosum
worsening post-prandial pain that leads to avoidance of food is usually suggestive of _____
abdominal angina (atherosclerosis of the mesenteric arteries)
IBS can lead to weight loss (t/f)
F
- diarrhea
- modified acid fast stain showing oocysts in stool is highly suggestive of ____________
cryptosporidium parvum
- self limited in immunocompetent
- persistent clinical course in immunocompromised
corkscrew esophagus on esophagogram
high amplitude esophageal contractions on manometry
chest pain and dysphagia
diffuse esophageal spasm
-tx with antispasmodics, dietary changes, psychiatric counseling
esophageal smooth muscle atrophy (loss of distal esophageal peristalsis) and incompetent LES
scleroderma
foot gets stuck in throat… male with halitosis and regurgitation but no pain
zenker’s diverticulum
absent peristalsis and super tight LES tone
achalasia
- alopecia, abnormal taste, bullous pustulous lesions surrounding body orifices and/or extremities, impaired wound healing
- IBD patient on TPN
zinc deficiency
selenium deficiency highly associated with _________
also not in TPN
cardiomyopathy
triad of carcinoid syndrome
flushing
valvular heart disease
diarrhea
patients with carcinoid syndrome are at risk for ____ deficiency
niacin
________ decreases the renal clearance of digoxin, causing ________ issues
verapamil GI issues (anorexia, N/V)
multiple duodenal ulcers and a jejunal ulcer are almost pathognomonic for _______
ZES
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
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
what to do if someone comes in with a classic presentation of appendicitis?
immediate surgery
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
_______ most common cause of LGIB in elderly
diverticulosis
_______ most common solid organ to be injured in blunt abd trauma
spleen
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
undifferentiated carcinoma of SCC origin seen in the nose of Mediterranean or Far East ppl
nasopharyngeal carcinoma
what is nasopharyngeal carcinoma highly assoc with?
EBV infection
how to tx duodenal hematoma
NG suction and parenteral nutrition
it will resorb spontaneously over time
opening snap assoc with what heart issue?
mitral stenosis
eggshell calcification of a liver cyst
most likely hydatid cyst
how to tx hydatid cyst
not aspiration due to risk of anaphylaxis
tc: surgically resect with albendazole
cysticercosis
cysts in the brain or muscle
taenia solium
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
recurrent pneumonia in the same area of the lung should make you suspect ________. Therefore, get a ____
- cancer or some sort of obstruction
- CT
proteinuria, easy bruisability, restrictive cardiomyopathy (thickened ventricular wall, normal ventricular dimensions, slightly reduced systolic function)
amyloidosis
capillary pulsations in fingers and lips may be assoc with ____
aortic regurgitation
parathyroid adenoma
pituitary tumors
enterohepatic tumors (pancreatic islet cell tumor)
MEN I
medullary thyroid cancer
pheochromocytoma
parathyroid hyperplasia
MEN IIA
medullary thyroid cancer
pheochromocytoma
other: mucosal and intestinal neuroma, marfanoid habitus
MEN IIB
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
dementia pts are at risk for pneumonia due to ______
impaired epiglottic function
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
murmur increases in intensity during valsalva
most likely HOCM
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 excisionpositive breath hydrogen positive stool for reducing substances low stool pH increased stool osmotic gap NO steatorrhea
lactose intolerance
what does S4 mean?
stiff LV due to restrictive cardiomyopathy or LVH from longstanding HTN
mid systolic click and late systolic murmur over cardiac apex
mitral valve prolapse
cor pulmonale is often caused by ______
you see JVD, right sided S3, RV heave, hepatomegaly, ascites, dependent edema, but NOT pulmonary congestion
COPD
chronic malabsorption can cause vitamin D deficiency which presents as:
_____ Ca
_____ phosphate
_____ PTH
low
low
high
________ is a potential complication of bronchiectasis
hemoptysis
NOT malignancy, LV failure, ptx, or PE
how to approach esophageal perforation
water soluble contrast esophagography
tx with abx, parenteral nutrition, surgical repair
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
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
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
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
needle shaped crystals on U/A indicate ______
uric acid stones (radiolucent)
ureteral colic can cause ileus (t/f)
yep
enteroclysis
used to dx small bowel tumors and other pathology
RQ ratios for:
carbohydrates
protein
lipid
1
- 8
- 7
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
fat malasorption can cause _______ oxalate absorption
this causes ______
increased
kidney stones
if you suspect boerhaave, you should get _____ to dx it for sure
gastrograffin swallow
how to tx stress fracture of metatarsal
rest and analgesics
someone has symptoms of claudication.. what’s the first test?
ABI
how to dx kidney stones
noncontrast CT
hemo unstable blunt abdominal trauma… after fluid resuscitation, what do you do?
FAST before possible exlap
if you see a carotid artery intimal flap, what do you do?
surgical repair
palpable breast mass in pts over 35… what’s the first test?
mammogram
unstable pt with blunt abdominal and pelvic trauma… FAST and DPL are negative… what do you do next?
pelvic angiography
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
trauma patient with nosebleed, what do you get before getting a head CT?
spine xray
OR you could get head and cspine CT
SBO with lactic acidosis, what do you do next?
laparotomy
penis fx… what to do?
RUG then surgery
how to tx femoral neck fxs?
in young ppl- ORIF
in old ppl- primary arthroplasty
tetanus: <3 doses and clean
toxoid
tetanus: at least 3 doses, clean
toxoid only if last dose was > 10 years ago
tetanus: <3 doses, dirty wound
toxoid and immunoglobulin
tetanus: at least 3 doses, dirty wound
toxoid if > 5 years since last dose
how to tx closed femoral shaft tx
closed intramedullary fixation
how to approach airway of an apneic pt with head injury
orotracheal intubation or cricothyroidectomy
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
O2 and CO2 of the following:
- PE and atelectasis
- asthma/COPD and hypoventilation
- hypoxia, hypocapnea
- hypoxia, hypercapnea
what abx for perforated appendix? (gram - and anaerobes)
cefotetan
teen with knee pain, no systemic sxs, sunburst radiology pattern, increased ALP
osteosarcoma
blue cells, fever, weight loss, onion skin in diaphyses of long bones/spine/pelvis
Ewing’s
adults with knee problems and soap bubble appearance on xray
osteoclastoma
after cardiac surgery…. fever, leukocytosis, tachycardia, chest pain but NO widened mediastinum
-tx?
postcardiotomy syndrome
-tx: pericardial puncture if tamponade, aspirin or steroids
how to tx acute mediastinitis and what does it often look like on CXR
widened mediastinum
tx wit drain, debride, abx
