uworld 10 Flashcards
What is eosinophilic esophagitis?
uncommon, px w/ dysphagia, heartburn, refractory acid reflux. Commonly px w/ other atopic illnesses. Chronic and indolent.
What is tick born paralysis and how px?
Due to neurotoxin from tick feeding. Ascending paralysis that may be greater in 1 leg or arm. CSF and CBC nml, no fever usually present.
What does chronic GERD predispose to?
esoph adenocarcinoma and benign esoph strictures. Can differentiate the by barium — assym in adenocar, circumferential in esoph strictures. Still need biopsy despite barium findings.
Px of spinal epidural abscess?
fever, severe focal back pain, radiculopathy, motor and sensory deficits, bowel or bladder dysfxn and eventual paralysis.
How spinal epidural abscesses form?
hematog spread from distant source, contig tissue infxn, direct incoulation (steroid injxn, epidural anesth), also IV drug use and immunocomp st r rx fx
What is amarosis fugax make one concerned for?
It is a warning sign for impending stroke.
Sx of idiopathic intracranial htn?
HA, xsient visual loss, pulsatile tinnitus, diplopia
Drugs that incrs risk for intracranial htn?
growth hormone, tetracyclines, excessive Vit A and its deriv (isotretinoin).
What are nml heart changes with aging?
dcrsd resting and max CO, dcrsd max HR, incrsd cntrxn and incrsd relaxation time, incrsd stiffness of myocardium.
What are general sx in botulism?
DESCENDING paralysis w/ early CN involvement. Commonly get pupillary abnom.
Sx of asbestosis?
prog dyspnea, bibasilar end inspiratory fine crackles & clubbing.
PFT findings with asbestosis?
Restrictive pattern, dcrsd LV, incrsd FEV1/FVC, dcrsd DLCO.
What drugs can cause autoimmune hemolysis?
alpha methyldopa and penicillin.
When find “albumino-cytologic dissociation”
with GBS.
What is most common mechanism with PSVT? How treat?
Most commnly 2/2 reentry to AV node? Tx by incrs vagal stimulation which dcrs AV node conductivity.
What is steps in bilirubin metab in liver?
- uptake from blood, 2. storage w/in hepatocyte, 3. conjugation with glucuronic acid. 4. biliary excretion
What is pathogenesis for gilbert’s?
dcrsd prodxn of UDP glucuronyl xferase which leads to dcrsd bilirubin glucuronidation and dcrsd uptake of bili.
What is crigler najjar type 1?
AR dx of bili metab that leads to svr jaundice and kernicterus. Req liver xplant for survival.
What is crigler najjar type 2
milder AR w/ survival into adulthood, w/ no kernicterus.
Major causes of empyema?
Strep pneumo, Staph aureus, Klebs. Can progress to polymicrob pop.
How tx empyema?
Requires empyema AND drainage.
Best test to determine incidenc?
Cohort study not case control
When need immediate tx for hypercalcemia?
If symptomatic moderate (12-14) or when svr (>14)
How treat “significant” hypercalcemia?
IV hydration, calcitonin, bisphosphonates
Most common causes of ectopic ACTH prodxn?
Small cell lung cancer, carcinoid syndromes (bronchial, pancreatic, thymus)
High ectopic ACTH presentation?
signif htn and hypokalemia (excess cortisol has mineralocortic act.), metab alkalosis, hyperpigmentation, no other si/sx of cushings
When how ppx against histo with HIV?
If CD4<100, and in endemic areas, ppx w/ itraconazole
How Kaposi’s sarcoma px? What causes?
reddish purple, dark vascular plaques or nodules on cutaneous or mucosal surfaces. Caused by HHV8
How tx peripheral arterial embolism?
Intra-arterial thrombolysis or mechanical embolectomy or surgical embolectomy. Do intraarterial fibrinolytic agent otherwise.
What is danger zone of pharynx?
between alar and prevertebral fascia, can drain into posterior mediastinum and cause necrotizing mediastinitis
What is ludwig’s angina?
infxn in submandibular space which begins in floor of mouth and extends thru.
Possible cause of htn in young women of childbearing age?
Think about meds, espec OCPs
How leukemia/ lymphoma cause anemia?
RBC progenitor cells replaced w/ cancer cells, lose ability to produce new RBCs.
How does embolic ischemic stroke px?
abrupt onset, maximal sx from start, occurs w/ afib, endocarditis, or carotid bruit. Commonly have infarcts in multiple vasc regions.
Cause of nephrotic syndrome in Hodgkins Lymphoma?
Minimal change most common, also FSGS possible. 2/2 IL 13 and other interleukin prodxn.
What carries corneal reflex sx?
V1 (opthalmic) branch, also provides sensation to scalp, forehead, eyelid, nose, sinuses.
What is role of facial nerve CN VII?
facial movement, taste in ant 2/3 of tongue, lacrimation, salivation, eyelid closing.
Sx of mixed essential cryoglobulinema?
palpable purpura, GMN, arthralgias, HSM, periph neuropathy, hypocomplementemia.
What is nl anion gap?
6 to 12, but increases with age
What is first line tx w/ OA?
first tx w/ acetominophen
What is one complication of aortic dissection? How does it px?
Can get aortic regurg due to aortic root dilatation –> px w/ rumbling diastolic murmur
How infective endocarditis commonly px in IV drug use?
Can get systemic manifestations such as septic pulmonary emboli, murmur often absent, heart failure rare
How do pulmonary septic emboli commonly present?
Get pulmo infilitrates, abscesses, infxns, pulmo gangrene, cavities on cxr
First step in eval of hyperbilirubinemia. How follow up?
First determine if conjugated or unconjugated. If unconjugated then either due to overprodxn (hemolysis, conjugation defect) or underexcretion (reduced uptake)
How workup elevated conjugated bilirubin?
look at liver enz, if all nml then likely dubin-johnson or Rotor syndrome, if elev AST/ALT — hepatitis, hemochromatosis, others on ddx
If incrsd conj w/ incrsd alk phos and nml AST/ALT?
ddx: cholestasis, obstrxn, PBC, PSC, choledocholithiasis. W/u w/ abd U/S and antimitochondrial AB. CT if U/S equivalent.
Pulmonary causes of hemopytsis?
bronchitis, PE, bronchiectasis, lung cancer, TB, lung abscesses, wegener’s goodpastures, SLE
What is measure in case control study?
exposure odds ratio
What is used in cohort studies?
look at relative risk, relative rate
What is effect of chronic renal failure on anion gap?
produces anion gap of hypochloremic metabolic acidosis
Si/sx of papilledema?
swelling of optic nerve head — enlargement of blind spot. Momentary visual loss depending on head position, rapid to permanent vision loss.
What is amarosis fugax?
Transient (few sec) loss of vision usually 2/2 vasc causes.
How manage hypovolemic hypernatremia?
IV NS until intravasc volume replaced. DO not correct faster than 0.5 meg Na/hr
How tx uremic pericarditis?
hemodialysis
Where is zinc primarily absorbed? How deficiency px?
Absorb in jejunum, defic px w/ alopecia, abnormal taste, pustules, bullae around bony orifices
Who at risk for zinc deficiency?
pt on TPN and IBD
When necessary to determine GI cause of iron deficiency anemia?
In adult male or post menopausal woman, start w/u w/ FOBT
What is lung histo change in alpha 1 antitrypsin defiency?
Panacinar emphysema
DDx for obstructive pattern PFTs?
low DLCO — emphysema; nl DLCO – chronic bronch; incrsd DLCO – asthma
How do emphysematous COPD px?
thin pts w/ svr dyspnea, hyperinflated chest, dcrsd vasc markings, dcrsd DLCO & mod O2 desat
How does bronchitis type COPD px?
chronic productive cough >/= 3 mo over 2 consec yrs due to hypersecretion of mucus and structural changes in tracheobronch tree, prom vasc markings, nml DLCO
Most common cause of atypical pneumonia?
mycoplasma, legionella, chlamydia, influenza, coxiella
How px of atypical pneumo different?
more mild course, more extrapulm findings, non productive cough
skin findings typical of mycoplasma?
erythema multiforme – target shaped lesions on extremities
Typical px of lew body dementia?
alterations in conciousness, disorganized speech, visual hallucinations, EPS, early compromise of exec fxn
Where else lewy bodies seen and how differentiate?
in parkinson but dementia px early in course with lewy body dementia.
Findings in NPH?
dementia, incontinence, gait abnormalities, broad based and shuffling w/ bradykinesia, no tremor
What is HIV nephropathy?
collapsing focal and segmental glomerulosclerosis, px w/ heav proteinuria and rapid devo of renal failure
WHat study used to determine incidence?
Must follow healthy individuals for time period to determine who becomes sick… this is a cohort study
What is leprosy?
chronic granulmoatous disease that mainly affects periph skin and nerves, due to mcobacterial leprae
How does early leprosy px?
Px as insensate hypopigmented plaque
How does late leprosy px?
progres nerve damage — muscle atrophy w/ conseuqent crippling deformities of hand.
How tx malignant otitis externa?
antipseudomonal abx ; aminoglycosides, quinolones (except moxi), cephalosporins, carbapenems (except ertapenem), aztreonam, ticarcillin, piperacillin
What is fibromuscular dysplasia?
Non inflamm cndtn caused by abnml cell develo in arterial wall that can lead to vessel stenosis, aneurysm, dissoc. Usually involves renal, carotids, vertebral arteries
Who screen for FMD?
women <50 w/ svr and resistant htn, htn onset before 35, sudden incrs in bp, sudden incrs in Cr after starting ACE,ARB
What bug are pts w/ hemochromatosis @ risk of getting?
listeria,
What is relation btwn P value and confidence interval?
inversely related, smaller the P value, the larger confidence interval. If null value (CI = 1.0) is w/in CI, the p value is > 0.05.
How does disseminated gonoccocus px?
high fvr, chills, tenosynovitis, migratory polyarthritis, skin rash w/ purpuric or pustular lesion w/ hemorrhagic component & cntrl necrosis
How does toxic shock syndrome px?
fever, erythema/desquamation, HA, N/V, myalgia
Best test for initial MI, for recurrent MI?
If first MI in long time — do troponin, most sensitive & specific, If recurrent MI in 1st week after MI, use CK-MB
Most common type of thyroid nodule?
benign colloid nodule most common
What is cause of anaphylactic rxn to blood products?
due to receiving of donor IgA when IgA deficient. Prevent with washing of RBCs
WHat is an amnestic Ab response?
response against minor RBC ag leading to delayed mild hemolysis 2-10 days after xfusion.
Causes of low Testosterone?
can be primary failure (low T, high FSH and LH), or secondary failure (low T, low/nml FSH, LH)
What are indiciations of acute R heart strain?
JVD w/ RBBB on ecg
Side effects of levodopa/carbidopa?
somnolence, confusion, hallucinations, dyskinesia, dystonia after long term therapy
Side effects of trihexyphenydil and benztropine?
anticholinergic drugs so get anticholinergic effects
What are side effects of amandatine?
ankle edema and livedo reticularis.
What are the dopamine agonists?
apomorphine, bromocriptine, pramipaxole, ropinorole
Side effects of dopamine agonists?
somnolence, hypotension, confusion, hallucinations
Normal albumin to protein gap is what? What does it suggest?
usually 3-4 difference btwn serum protein and albumin. If elevated gap, think multiple myeloma
What is cause of chagas disease?
tyrpanosoma cruzii?
Common causes of esophagitis in HIV?
CMV, HSV, candida, idiopathic/apthous
How does candidal esophagitis in HIV px?
white scrapable plaque in mouth, odynophagia, not usually severe
How does HSV esoph px?
herpetic vesicles and round/ovoid ulcers
How does CMV esophagitis px?
linear, deep ulcers esp in distal esophagus
How tx uncomplicated UTI in nonpreg woman?
bactrim x 3 days, nitrofurantoin x 5 days, single dose of fosfomycin, only do urine cx if initial tx fails
How tx complicated cystitis?
quinolones x 10-14 days after obtaining urine cx
What is common arrhythmia w/ hyperthyroidism?
afib
What are the K sparing diuretics?
spironolactone, eplerenone, amiloride, triamterene
Sensitivity does what?
tells ability of test to determine which patients have disease. If negative then patient likely not to have disease.
What is receiver operating characteristic?
Plots true positive rate (sensitivity) against false pos rate (1-specificity), if linear relationship then test provides no useful info and diagnosis produced by test at random.
What is precision?
proportion of true positive out of total # of positive results produced by test in given pop, equivalent to positive predictive value
Relationship to sensitivity, specificity to npv and ppv?
as sensitivity incrs then NPV increases, as specificity incrs then PPV increases
What are causes of osteomalacia?
malabsorption, intestinal byapss surgery, celiac sprue, chronic liver disease, CKD
si/sx osteomalacia?
may be asx, px w/ bone pain, muscle weakness, muscle cramps, difficulty ambulating, waddling gait
Lab findings w/ osteomalacia?
incrsd alk phos, incrsd PTH, dcrsd calcium, vit D, urinary Ca
Pathophys of osteomalacia?
due to defective mineralization of bone matrix due to Ca and Phos deficiency 2/2 to vit D deficiency
What does plateau pressure (on PFT) tell you?
Can calculate compliance as gives you elastic pressure of lung
What is peak airway pressure and when significant?
PAP= resistive P + plateua P. if elevated w/ nml plateau P, problem w/ airway resistance sugg bronchospasm, mucus plug, ETT obstruction
Secondary probs assoc w/ polycythemia vera?
incrsd risk of peptic ulceration 2/2 histamine release, gout 2/2 inrsd cell turnover
who at highest risk for SLE?
young AA women aged 20-40
Px of sarcoidosis?
cough + erythema nodosum, abn cxr, hyperCa, incrsd ACE, noncaseating granulomas
What is murmur of mitral regurg?
pansystolic @ apex w/ radiation to axilla.
Best screening for Hep B virus?
HbsAg and IgM anti- HBc . IgM anti-hbc signals acute infxn and IgG HbC signals recovery
How tx withdrawal sx in opioid dependent patients?
methadone either PO or IM
When induration of >5 mm suggest TB infxn?
If HIV infctd, recent contact w/ TB infected, signs of TB on cxr, organ xplants pts or immunosuppressed
When ppd >10 suggest positive test?
individual who recently immigrated, IV drug users, high risk setting employee, pts w/ DM, CKD, hematol probs, teens exposed to high risk adults
What is hospice model?
focus on QOL, not prolongation, sx control services provided @ non-acute center
What is requirement to enter hospice?
prognosis of </= 6 mo w/ irreversible decline in clinical/fxnl state, NO DNR/DNI req
How manage cryptococcal meninigits?
IV ampho plus oral flucytosine, once see clinical improvement, switch to PO fluconazole. Do HIV w/u if not already dx.
Signs of TCA OD?
hyperthermia, seizures, hypotension, dilated pupils, flushed/dry skin, intestinal ileus (anticholinergic sx), get QRS widening w/ risk of ventric arryth
How manage TCA OD?
sodium bicarb — narrows QRS complex
What measure determines severity of TCA OD?
degree of QRS widening
What tests are specific for disc herniation?
straight leg raise and crossed straight leg test
How does disc herniation px?
low back pain radiating down buttock and below knee in dermatomal pattern
How does spinal stenosis px?
low back pain worse with activity and relieved w/ rest
What is typical px of metastatic bone pain?
typically constant and worse @ night/w/ rest
what is vitiligo?
autoimmune destxn of melanocytes with predilection for extremities, around body orifices.
How remember cyp induces?
“ALL MOVE FAST” Grizzly-ofulvin (griseofulvin) quickidine (quinidine) PHEN-PHEN (phenytoin, phenobarbital), CARbamazapine goes vroom vroom, RifAMPin
How remember inhibitors?
inhibit yourself from drinking ETOH from a KEG, It will make you a SICCO. (ETOH, ketoconaz, erythromycin/macrolides, grapefruit, sulfon, isoniazid, cimetidine, chloramphen, omeprazol
What r si/sx of theophylline toxicity?
CNS sx: HA, insomnia, seizures, GI probs (N/V), arryth,
Concern w/ verapamil?
decreases renal clearance of other drugs
What are side effects of digoxin toxicity?
anorexia, N/V, arrythm — vtach, accel jxn rhythm
Xray findings w/ osteomalacia?
dcrsd bone density, thinning cortex, eventual codfish vertebral bodies (concave shape), pseudo fx
Typical description of AK?
red papules w/ central scaly sandpaper texture, fewer than 1% become SCC
How tx amebic abscess of liver?
oral flagyl x 1 week
What is px of spinal epidural abscess?
triad of fvr, severe focal back pain + neuro deficits, also get progressive radiculop, motor and sensory deficits, bowel or bladder dysfxn, eventual paraylsis
What are risk fx for spinal epidural abscess?
IV drug use, immunocomp state, spread from contig distant source, spinal trauma or surgery
Most common form of skin cancer?
Basal cell carcinoma
How tx drug induced AIN?
discontinue offending agent
What are tx for Dresslers?
NSAIDS are 1st line, if those fail then steroids
Most common nephropathy cause in AA?
FSGS.
What other associatons exists w/ FSGS?
obesity, HIV, IV drug use
most common nephropathy in non-blacks/?
membranous nephropathy
How w/u and tx primary hyperPTH?
1st do sestamibi scan, then do paraythroidectomy if primarily 2/2 hyperplasia.
When parathyroidectomy indicated in asx pt?
IF Ca>/= 11.5, age <2.5 any site, reduced renal fxn
What should be calculated if ABG given w/ metab acidosis?
winters formula to determine pCO2 response
Cause of hypoxemia in PCP pneumonia?
incrsd alveolar-arterial O2 gradient 2/2 alveolar and interstitial inflamm.
What is common cause of incrsd left atrial pressure?
LV failure or mitral valve problem.
DDX of spherocytes on smear?
hereditary or AIHA
How dx AIHA?
Direct coombs test positive w/ extravasc hemolysis, neg family hx
