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Uworld questions > uworld 10 > Flashcards

uworld 10 Flashcards

1
Q

What is eosinophilic esophagitis?

A

uncommon, px w/ dysphagia, heartburn, refractory acid reflux. Commonly px w/ other atopic illnesses. Chronic and indolent.

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2
Q

What is tick born paralysis and how px?

A

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.

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3
Q

What does chronic GERD predispose to?

A

esoph adenocarcinoma and benign esoph strictures. Can differentiate the by barium — assym in adenocar, circumferential in esoph strictures. Still need biopsy despite barium findings.

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4
Q

Px of spinal epidural abscess?

A

fever, severe focal back pain, radiculopathy, motor and sensory deficits, bowel or bladder dysfxn and eventual paralysis.

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5
Q

How spinal epidural abscesses form?

A

hematog spread from distant source, contig tissue infxn, direct incoulation (steroid injxn, epidural anesth), also IV drug use and immunocomp st r rx fx

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6
Q

What is amarosis fugax make one concerned for?

A

It is a warning sign for impending stroke.

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7
Q

Sx of idiopathic intracranial htn?

A

HA, xsient visual loss, pulsatile tinnitus, diplopia

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8
Q

Drugs that incrs risk for intracranial htn?

A

growth hormone, tetracyclines, excessive Vit A and its deriv (isotretinoin).

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9
Q

What are nml heart changes with aging?

A

dcrsd resting and max CO, dcrsd max HR, incrsd cntrxn and incrsd relaxation time, incrsd stiffness of myocardium.

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10
Q

What are general sx in botulism?

A

DESCENDING paralysis w/ early CN involvement. Commonly get pupillary abnom.

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11
Q

Sx of asbestosis?

A

prog dyspnea, bibasilar end inspiratory fine crackles & clubbing.

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12
Q

PFT findings with asbestosis?

A

Restrictive pattern, dcrsd LV, incrsd FEV1/FVC, dcrsd DLCO.

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13
Q

What drugs can cause autoimmune hemolysis?

A

alpha methyldopa and penicillin.

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14
Q

When find “albumino-cytologic dissociation”

A

with GBS.

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15
Q

What is most common mechanism with PSVT? How treat?

A

Most commnly 2/2 reentry to AV node? Tx by incrs vagal stimulation which dcrs AV node conductivity.

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16
Q

What is steps in bilirubin metab in liver?

A
  1. uptake from blood, 2. storage w/in hepatocyte, 3. conjugation with glucuronic acid. 4. biliary excretion
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17
Q

What is pathogenesis for gilbert’s?

A

dcrsd prodxn of UDP glucuronyl xferase which leads to dcrsd bilirubin glucuronidation and dcrsd uptake of bili.

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18
Q

What is crigler najjar type 1?

A

AR dx of bili metab that leads to svr jaundice and kernicterus. Req liver xplant for survival.

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19
Q

What is crigler najjar type 2

A

milder AR w/ survival into adulthood, w/ no kernicterus.

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20
Q

Major causes of empyema?

A

Strep pneumo, Staph aureus, Klebs. Can progress to polymicrob pop.

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21
Q

How tx empyema?

A

Requires empyema AND drainage.

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22
Q

Best test to determine incidenc?

A

Cohort study not case control

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23
Q

When need immediate tx for hypercalcemia?

A

If symptomatic moderate (12-14) or when svr (>14)

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24
Q

How treat “significant” hypercalcemia?

A

IV hydration, calcitonin, bisphosphonates

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25
Q

Most common causes of ectopic ACTH prodxn?

A

Small cell lung cancer, carcinoid syndromes (bronchial, pancreatic, thymus)

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26
Q

High ectopic ACTH presentation?

A

signif htn and hypokalemia (excess cortisol has mineralocortic act.), metab alkalosis, hyperpigmentation, no other si/sx of cushings

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27
Q

When how ppx against histo with HIV?

A

If CD4<100, and in endemic areas, ppx w/ itraconazole

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28
Q

How Kaposi’s sarcoma px? What causes?

A

reddish purple, dark vascular plaques or nodules on cutaneous or mucosal surfaces. Caused by HHV8

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29
Q

How tx peripheral arterial embolism?

A

Intra-arterial thrombolysis or mechanical embolectomy or surgical embolectomy. Do intraarterial fibrinolytic agent otherwise.

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30
Q

What is danger zone of pharynx?

A

between alar and prevertebral fascia, can drain into posterior mediastinum and cause necrotizing mediastinitis

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31
Q

What is ludwig’s angina?

A

infxn in submandibular space which begins in floor of mouth and extends thru.

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32
Q

Possible cause of htn in young women of childbearing age?

A

Think about meds, espec OCPs

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33
Q

How leukemia/ lymphoma cause anemia?

A

RBC progenitor cells replaced w/ cancer cells, lose ability to produce new RBCs.

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34
Q

How does embolic ischemic stroke px?

A

abrupt onset, maximal sx from start, occurs w/ afib, endocarditis, or carotid bruit. Commonly have infarcts in multiple vasc regions.

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35
Q

Cause of nephrotic syndrome in Hodgkins Lymphoma?

A

Minimal change most common, also FSGS possible. 2/2 IL 13 and other interleukin prodxn.

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36
Q

What carries corneal reflex sx?

A

V1 (opthalmic) branch, also provides sensation to scalp, forehead, eyelid, nose, sinuses.

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37
Q

What is role of facial nerve CN VII?

A

facial movement, taste in ant 2/3 of tongue, lacrimation, salivation, eyelid closing.

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38
Q

Sx of mixed essential cryoglobulinema?

A

palpable purpura, GMN, arthralgias, HSM, periph neuropathy, hypocomplementemia.

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39
Q

What is nl anion gap?

A

6 to 12, but increases with age

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40
Q

What is first line tx w/ OA?

A

first tx w/ acetominophen

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41
Q

What is one complication of aortic dissection? How does it px?

A

Can get aortic regurg due to aortic root dilatation –> px w/ rumbling diastolic murmur

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42
Q

How infective endocarditis commonly px in IV drug use?

A

Can get systemic manifestations such as septic pulmonary emboli, murmur often absent, heart failure rare

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43
Q

How do pulmonary septic emboli commonly present?

A

Get pulmo infilitrates, abscesses, infxns, pulmo gangrene, cavities on cxr

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44
Q

First step in eval of hyperbilirubinemia. How follow up?

A

First determine if conjugated or unconjugated. If unconjugated then either due to overprodxn (hemolysis, conjugation defect) or underexcretion (reduced uptake)

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45
Q

How workup elevated conjugated bilirubin?

A

look at liver enz, if all nml then likely dubin-johnson or Rotor syndrome, if elev AST/ALT — hepatitis, hemochromatosis, others on ddx

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46
Q

If incrsd conj w/ incrsd alk phos and nml AST/ALT?

A

ddx: cholestasis, obstrxn, PBC, PSC, choledocholithiasis. W/u w/ abd U/S and antimitochondrial AB. CT if U/S equivalent.

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47
Q

Pulmonary causes of hemopytsis?

A

bronchitis, PE, bronchiectasis, lung cancer, TB, lung abscesses, wegener’s goodpastures, SLE

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48
Q

What is measure in case control study?

A

exposure odds ratio

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49
Q

What is used in cohort studies?

A

look at relative risk, relative rate

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50
Q

What is effect of chronic renal failure on anion gap?

A

produces anion gap of hypochloremic metabolic acidosis

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51
Q

Si/sx of papilledema?

A

swelling of optic nerve head — enlargement of blind spot. Momentary visual loss depending on head position, rapid to permanent vision loss.

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52
Q

What is amarosis fugax?

A

Transient (few sec) loss of vision usually 2/2 vasc causes.

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53
Q

How manage hypovolemic hypernatremia?

A

IV NS until intravasc volume replaced. DO not correct faster than 0.5 meg Na/hr

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54
Q

How tx uremic pericarditis?

A

hemodialysis

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55
Q

Where is zinc primarily absorbed? How deficiency px?

A

Absorb in jejunum, defic px w/ alopecia, abnormal taste, pustules, bullae around bony orifices

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56
Q

Who at risk for zinc deficiency?

A

pt on TPN and IBD

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57
Q

When necessary to determine GI cause of iron deficiency anemia?

A

In adult male or post menopausal woman, start w/u w/ FOBT

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58
Q

What is lung histo change in alpha 1 antitrypsin defiency?

A

Panacinar emphysema

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59
Q

DDx for obstructive pattern PFTs?

A

low DLCO — emphysema; nl DLCO – chronic bronch; incrsd DLCO – asthma

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60
Q

How do emphysematous COPD px?

A

thin pts w/ svr dyspnea, hyperinflated chest, dcrsd vasc markings, dcrsd DLCO & mod O2 desat

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61
Q

How does bronchitis type COPD px?

A

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

62
Q

Most common cause of atypical pneumonia?

A

mycoplasma, legionella, chlamydia, influenza, coxiella

63
Q

How px of atypical pneumo different?

A

more mild course, more extrapulm findings, non productive cough

64
Q

skin findings typical of mycoplasma?

A

erythema multiforme – target shaped lesions on extremities

65
Q

Typical px of lew body dementia?

A

alterations in conciousness, disorganized speech, visual hallucinations, EPS, early compromise of exec fxn

66
Q

Where else lewy bodies seen and how differentiate?

A

in parkinson but dementia px early in course with lewy body dementia.

67
Q

Findings in NPH?

A

dementia, incontinence, gait abnormalities, broad based and shuffling w/ bradykinesia, no tremor

68
Q

What is HIV nephropathy?

A

collapsing focal and segmental glomerulosclerosis, px w/ heav proteinuria and rapid devo of renal failure

69
Q

WHat study used to determine incidence?

A

Must follow healthy individuals for time period to determine who becomes sick… this is a cohort study

70
Q

What is leprosy?

A

chronic granulmoatous disease that mainly affects periph skin and nerves, due to mcobacterial leprae

71
Q

How does early leprosy px?

A

Px as insensate hypopigmented plaque

72
Q

How does late leprosy px?

A

progres nerve damage — muscle atrophy w/ conseuqent crippling deformities of hand.

73
Q

How tx malignant otitis externa?

A

antipseudomonal abx ; aminoglycosides, quinolones (except moxi), cephalosporins, carbapenems (except ertapenem), aztreonam, ticarcillin, piperacillin

74
Q

What is fibromuscular dysplasia?

A

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

75
Q

Who screen for FMD?

A

women <50 w/ svr and resistant htn, htn onset before 35, sudden incrs in bp, sudden incrs in Cr after starting ACE,ARB

76
Q

What bug are pts w/ hemochromatosis @ risk of getting?

A

listeria,

77
Q

What is relation btwn P value and confidence interval?

A

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.

78
Q

How does disseminated gonoccocus px?

A

high fvr, chills, tenosynovitis, migratory polyarthritis, skin rash w/ purpuric or pustular lesion w/ hemorrhagic component & cntrl necrosis

79
Q

How does toxic shock syndrome px?

A

fever, erythema/desquamation, HA, N/V, myalgia

80
Q

Best test for initial MI, for recurrent MI?

A

If first MI in long time — do troponin, most sensitive & specific, If recurrent MI in 1st week after MI, use CK-MB

81
Q

Most common type of thyroid nodule?

A

benign colloid nodule most common

82
Q

What is cause of anaphylactic rxn to blood products?

A

due to receiving of donor IgA when IgA deficient. Prevent with washing of RBCs

83
Q

WHat is an amnestic Ab response?

A

response against minor RBC ag leading to delayed mild hemolysis 2-10 days after xfusion.

84
Q

Causes of low Testosterone?

A

can be primary failure (low T, high FSH and LH), or secondary failure (low T, low/nml FSH, LH)

85
Q

What are indiciations of acute R heart strain?

A

JVD w/ RBBB on ecg

86
Q

Side effects of levodopa/carbidopa?

A

somnolence, confusion, hallucinations, dyskinesia, dystonia after long term therapy

87
Q

Side effects of trihexyphenydil and benztropine?

A

anticholinergic drugs so get anticholinergic effects

88
Q

What are side effects of amandatine?

A

ankle edema and livedo reticularis.

89
Q

What are the dopamine agonists?

A

apomorphine, bromocriptine, pramipaxole, ropinorole

90
Q

Side effects of dopamine agonists?

A

somnolence, hypotension, confusion, hallucinations

91
Q

Normal albumin to protein gap is what? What does it suggest?

A

usually 3-4 difference btwn serum protein and albumin. If elevated gap, think multiple myeloma

92
Q

What is cause of chagas disease?

A

tyrpanosoma cruzii?

93
Q

Common causes of esophagitis in HIV?

A

CMV, HSV, candida, idiopathic/apthous

94
Q

How does candidal esophagitis in HIV px?

A

white scrapable plaque in mouth, odynophagia, not usually severe

95
Q

How does HSV esoph px?

A

herpetic vesicles and round/ovoid ulcers

96
Q

How does CMV esophagitis px?

A

linear, deep ulcers esp in distal esophagus

97
Q

How tx uncomplicated UTI in nonpreg woman?

A

bactrim x 3 days, nitrofurantoin x 5 days, single dose of fosfomycin, only do urine cx if initial tx fails

98
Q

How tx complicated cystitis?

A

quinolones x 10-14 days after obtaining urine cx

99
Q

What is common arrhythmia w/ hyperthyroidism?

A

afib

100
Q

What are the K sparing diuretics?

A

spironolactone, eplerenone, amiloride, triamterene

101
Q

Sensitivity does what?

A

tells ability of test to determine which patients have disease. If negative then patient likely not to have disease.

102
Q

What is receiver operating characteristic?

A

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.

103
Q

What is precision?

A

proportion of true positive out of total # of positive results produced by test in given pop, equivalent to positive predictive value

104
Q

Relationship to sensitivity, specificity to npv and ppv?

A

as sensitivity incrs then NPV increases, as specificity incrs then PPV increases

105
Q

What are causes of osteomalacia?

A

malabsorption, intestinal byapss surgery, celiac sprue, chronic liver disease, CKD

106
Q

si/sx osteomalacia?

A

may be asx, px w/ bone pain, muscle weakness, muscle cramps, difficulty ambulating, waddling gait

107
Q

Lab findings w/ osteomalacia?

A

incrsd alk phos, incrsd PTH, dcrsd calcium, vit D, urinary Ca

108
Q

Pathophys of osteomalacia?

A

due to defective mineralization of bone matrix due to Ca and Phos deficiency 2/2 to vit D deficiency

109
Q

What does plateau pressure (on PFT) tell you?

A

Can calculate compliance as gives you elastic pressure of lung

110
Q

What is peak airway pressure and when significant?

A

PAP= resistive P + plateua P. if elevated w/ nml plateau P, problem w/ airway resistance sugg bronchospasm, mucus plug, ETT obstruction

111
Q

Secondary probs assoc w/ polycythemia vera?

A

incrsd risk of peptic ulceration 2/2 histamine release, gout 2/2 inrsd cell turnover

112
Q

who at highest risk for SLE?

A

young AA women aged 20-40

113
Q

Px of sarcoidosis?

A

cough + erythema nodosum, abn cxr, hyperCa, incrsd ACE, noncaseating granulomas

114
Q

What is murmur of mitral regurg?

A

pansystolic @ apex w/ radiation to axilla.

115
Q

Best screening for Hep B virus?

A

HbsAg and IgM anti- HBc . IgM anti-hbc signals acute infxn and IgG HbC signals recovery

116
Q

How tx withdrawal sx in opioid dependent patients?

A

methadone either PO or IM

117
Q

When induration of >5 mm suggest TB infxn?

A

If HIV infctd, recent contact w/ TB infected, signs of TB on cxr, organ xplants pts or immunosuppressed

118
Q

When ppd >10 suggest positive test?

A

individual who recently immigrated, IV drug users, high risk setting employee, pts w/ DM, CKD, hematol probs, teens exposed to high risk adults

119
Q

What is hospice model?

A

focus on QOL, not prolongation, sx control services provided @ non-acute center

120
Q

What is requirement to enter hospice?

A

prognosis of </= 6 mo w/ irreversible decline in clinical/fxnl state, NO DNR/DNI req

121
Q

How manage cryptococcal meninigits?

A

IV ampho plus oral flucytosine, once see clinical improvement, switch to PO fluconazole. Do HIV w/u if not already dx.

122
Q

Signs of TCA OD?

A

hyperthermia, seizures, hypotension, dilated pupils, flushed/dry skin, intestinal ileus (anticholinergic sx), get QRS widening w/ risk of ventric arryth

123
Q

How manage TCA OD?

A

sodium bicarb — narrows QRS complex

124
Q

What measure determines severity of TCA OD?

A

degree of QRS widening

125
Q

What tests are specific for disc herniation?

A

straight leg raise and crossed straight leg test

126
Q

How does disc herniation px?

A

low back pain radiating down buttock and below knee in dermatomal pattern

127
Q

How does spinal stenosis px?

A

low back pain worse with activity and relieved w/ rest

128
Q

What is typical px of metastatic bone pain?

A

typically constant and worse @ night/w/ rest

129
Q

what is vitiligo?

A

autoimmune destxn of melanocytes with predilection for extremities, around body orifices.

130
Q

How remember cyp induces?

A

“ALL MOVE FAST” Grizzly-ofulvin (griseofulvin) quickidine (quinidine) PHEN-PHEN (phenytoin, phenobarbital), CARbamazapine goes vroom vroom, RifAMPin

131
Q

How remember inhibitors?

A

inhibit yourself from drinking ETOH from a KEG, It will make you a SICCO. (ETOH, ketoconaz, erythromycin/macrolides, grapefruit, sulfon, isoniazid, cimetidine, chloramphen, omeprazol

132
Q

What r si/sx of theophylline toxicity?

A

CNS sx: HA, insomnia, seizures, GI probs (N/V), arryth,

133
Q

Concern w/ verapamil?

A

decreases renal clearance of other drugs

134
Q

What are side effects of digoxin toxicity?

A

anorexia, N/V, arrythm — vtach, accel jxn rhythm

135
Q

Xray findings w/ osteomalacia?

A

dcrsd bone density, thinning cortex, eventual codfish vertebral bodies (concave shape), pseudo fx

136
Q

Typical description of AK?

A

red papules w/ central scaly sandpaper texture, fewer than 1% become SCC

137
Q

How tx amebic abscess of liver?

A

oral flagyl x 1 week

138
Q

What is px of spinal epidural abscess?

A

triad of fvr, severe focal back pain + neuro deficits, also get progressive radiculop, motor and sensory deficits, bowel or bladder dysfxn, eventual paraylsis

139
Q

What are risk fx for spinal epidural abscess?

A

IV drug use, immunocomp state, spread from contig distant source, spinal trauma or surgery

140
Q

Most common form of skin cancer?

A

Basal cell carcinoma

141
Q

How tx drug induced AIN?

A

discontinue offending agent

142
Q

What are tx for Dresslers?

A

NSAIDS are 1st line, if those fail then steroids

143
Q

Most common nephropathy cause in AA?

A

FSGS.

144
Q

What other associatons exists w/ FSGS?

A

obesity, HIV, IV drug use

145
Q

most common nephropathy in non-blacks/?

A

membranous nephropathy

146
Q

How w/u and tx primary hyperPTH?

A

1st do sestamibi scan, then do paraythroidectomy if primarily 2/2 hyperplasia.

147
Q

When parathyroidectomy indicated in asx pt?

A

IF Ca>/= 11.5, age <2.5 any site, reduced renal fxn

148
Q

What should be calculated if ABG given w/ metab acidosis?

A

winters formula to determine pCO2 response

149
Q

Cause of hypoxemia in PCP pneumonia?

A

incrsd alveolar-arterial O2 gradient 2/2 alveolar and interstitial inflamm.

150
Q

What is common cause of incrsd left atrial pressure?

A

LV failure or mitral valve problem.

151
Q

DDX of spherocytes on smear?

A

hereditary or AIHA

152
Q

How dx AIHA?

A

Direct coombs test positive w/ extravasc hemolysis, neg family hx

Uworld questions (13 decks)

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