UWORLD Flashcards
Patient with history of plaque psoriasis who has painful skin rash, fevers, malaise after stopping high-potency topical corticosteroids. Most likely diagnosis?
acute pustular psoriasis
Patient who comes in with pneumonia type symptoms who in the history, recently went to a hot tub. Most likely organism to cause this?
Mycobacterium avium complex
Patient presents with 2 day history of nausea, vomiting, hypertension, hyperactive bowel sounds, myalgias. home medications include morphine. Most likely cause?
opioid withdrawal
Patient with fatigue, flu like symptoms, history of autoimmune disease, slightly hypotensive, tachycardic, hyponatremia, hyperkalemia, is concerning for?
adrenal insufficiency
Sildenafil use in the treatment for erectile dysfunction is contraindicated in patients taking what type of medication for angina?
nitrates due to hypotension
autosomal dominant polycystic kidney disease is associated with cysts in what other areas?
hepatic cysts, pancreatic cysts, and cerebral aneurysms
Patient who presents with CAP and initiated on antibiotics who develops cholestatic liver disease on labs. Imaging work up reveals no gallstones, biliary sludge and a normal common bile duct. Most likely cause?
antibiotic toxicity leading to intrahepatic cholestasis
Patient with asthma, history of nasal polyps, who develops worsening shortness of breath after starting NSAIDs. Most likely diagnosis and most appropriate treatment?
Aspirin-exacerbated respiratory disease
Leukotriene antagonist (montelukast)
Patient with neurosyphilis and penicillin allergy. Next best step in treatment?
pencillin after desensitization
Primary prevention criteria for implantable cardioverter-defibrillator placement in patients with HF?
EF <30% and prior MI, at least 40 days post-MI and 3 months post revascularization
or EF <35% with NYHA class II or III symptoms
Patient with recurrent oral ulcers, acne, and genital ulcers brings up concern for which diagnosis?
Behcet disease
Patient with CKD who has prolonged epistaxis. First line treatment and mechanism of action?
desmopressin
Stimulates the release of von-Willebrand factor
when to start screening for colon cancer in patients with ulcerative colitis?
8-10 years after diagnosis and every 1-3 years thereafter
When to give aspirin and start DVT ppx lovenox after a patient comes in with ischemic stroke and receives tPA?
24 hours after tPA administration, give both
High intensity statins can increase risk of developing or worsen known what diagnosis?
diabetes mellitus
Patient with recurrent high fevers, polyarticular arthritis, evanescent macular rash, leukocytosis, and elevated serum ferritin levels. Most likely diagnosis?
Adult-onset Still’s disease
first line therapy for cutaneous warts?
topical salicylic acid
Patient with pleural effusion. pH 7.18, pleural fluid glucose 45, gram stain with neutrophils and gram-negative rods. Next best step in management apart from starting broad spectrum antibiotics?
chest tube placement
Patient with bilateral leg pain in calves and thighs when walking. Gets better when leaning over shopping cart. Pulses intact and normal. Test to establish correct diagnosis?
MRI of lumbar spine
Patient with PMH of HLD, gout, HTN, CKD, DJD of hips and knees presents with proximal muscle weakness, myalgia, and neuropathy. Home meds include lisinopril, allopurinol, colchicine, atorvastatin, and acetaminophen.
CK elevated to 15K. Muscle biopsy shows cytoplasmic vacuolization and no inflammation. Most likely diagnosis?
colchicine neuromyopathy
Patient with AMS, elevated osmolar gap, normal anion gap, and ketonuria/ketonemia, concerned for ingestion. Most likely cause?
isopropyl alcohol ingestion
Female 45 y/o patient with pruritus, fatigue, hepatomegaly, significantly elevated Alk phos, mildly elevated AST/ALT, predominantly direct hyperbilirubinemia. Most likely diagnosis? Sensitive marker for diagnosis? Best treatment option?
primary biliary cholangitis
Antimitochondrial antibodies
ursodeoxycholic acid
Hospice patient dealing with major depression. Best agent to use to help with this?
psychostimulants such as methylphenidate
African American 32 y/o male with symptoms of hypercalcemia, and chest xray shows hilar adenopathy. Most likely diagnosis?
sarcoidosis
Patient who is immunocompromised who is found to have pneumonia and brain abscess. Most likely organism? Treatment?
nocardiosis
bactrim
How does valproic acid cause encephalopathy?
causes elevated serum ammonia levels
Brainstem stroke should be consider in patients with cranial nerve deficits and contralateral hemiparesis or hemisensory loss
Cranial nerve involvement in strokes involving midbrain, pons, and medulla?
Midbrain: oculomotor (III) and trochlear (IV)
Pons: trigeminal (V), abducens (VI), facial (VII), vestibulocochlear (VIII)
Medulla: glossopharyngeal (IX), vagus (X), spinal accessory (XI), and hypoglossal (XII)
Patient with contact of those with active TB should be screened with tuberculin skin test. If this is positive but they do not have symptoms, this is considered latent TB infection. What should these patients be treated with?
daily rifampin for 4 months
OR
daily rifampin and INH for 3 months
OR
Weekly rifapentine and INH for 3 months
when treating DKA, at what level of K should you stop replacement while giving insulin?
> 5.3
Dyspnea on exertion and orthopnea after undergoing cardiac surgery is concerning for what?
How to diagnose?
unilateral diaphragmatic paralysis
sniff test
Best treatment for patient with PH and HFpEF?
MRA (spironolactone) and SGLT-2i
patient in myasthenic crisis who is intubated. Most appropriate treatment for rapid improvement?
plasma exchange
Middiastolic rumble and a opening snap heard at cardiac apex is indicative of what cardiac abnormality?
Associated with what prior history?
mitral stenosis
history of rheumatic heart disease
Patient with normocytic anemia, massive splenomegaly, and teardrop cells on peripheral smear. Most likely diagnosis?
primary myelofibrosis
Patient with ARDS would benefit from what tidal volume?
low tidal volume ventilation
Patient who had sore throat 1 week prior which did not resolve with antibiotics, presents with fevers and severe throat pain. Right side of neck is swollen and tender. Most concerning diagnosis? Most causative type of organism?
Lemierre’s syndrome
anaerobic organism, most commonly Fusobacterium necrophorum
Contraindication to percutaneous mitral balloon valvotomy?
severe mitral regurgitation
In a patient with known chronic slow-transit constipation, what type of laxative is most beneficial?
bulk forming such as fiber
Patient with HIV and new oral thrush. Should they be empirically treated for Candida esophagitis? and what agent should be used?
yes, oral fluconazole
Patient who has acute unilateral knee pain, recently underwent parathyroidectomy. Most likely diagnosis?
pseudogout flare
What medication can cause false positive results on dexamethasone suppression test, used to diagnose Cushing syndrome?
What test should be used instead?
estrogen (OCPs)
Late-night salivary cortisol
Patient with foot drop should be evaluated with what imaging modality?
MRI lumbar spine
Patient with concerns for mesenteric ischemia, history of vasculopathy, has testicular swelling, history of hepatitis B. Most likely diagnosis?
polyarteritis nodosa
Young female with headaches, visual symptoms, tinnitus, and diplopia. MRI of head without any significant abnormalities. Next investigative step and concerning diagnosis?
Lumbar puncture to look for elevated opening pressure, indicative of idiopathic intracranial hypertension
Patient with heartburn, underoges EGD which shows Barrett esophagus with high-grade dysplasia. Next best step in management?
endoscopic eradication therapy (radiofrequency ablation, cryotherapy, photodynamic therapy)
Patient with hypertension, hypokalemia, elevated plasma aldosterone to renin ratio. Most likely diagnosis? Diagnosis is confirmed with what test? CT of adrenals are normal, next best step in management?
primary hyperaldosteronism
aldosterone suppression test
adrenal venous sampling
Patient that started on orlistat and exenatide now having abdominal distension, flatus, and fecal incontinence. Next best recommendation?
start low-fat diet
Patient that is sexually active, presents with maculopapular rash on trunk and extremities, hair loss, lymphadenopathy, is concerning for what disease?
secondary syphilis
empiric treatment for bacterial meningitis should be with what antibiotics?
cefepime and vancomycin
what is needed for diagnosis of celiac disease?
endoscopy with biopsy
which post MI complication is associated most commonly with a posterior MI and occurs 3-5 days afterwards?
papillary muscle rupture
T score indicative of osteoporosis? osteopenia?
-2.5 or less
-1.0 to -2.4
More severe psoriasis is associated with what other disease process?
HIV
Patient with multiple sclerosis who is being treated with natalizumab (recombinant monoclonal antibody against alpha-4 intergrins). They are at increased risk for what disease and should be screened for what prior to starting the drug?
progressive multifocal leukoencephalopathy
Should screen for JC virus
Patient with history of chronic pancreatitis, and you see gastric varices in the stomach. Most likely cause of varices?
splenic vein thrombosis
Patient who undergoes PCI with DES placement is started on DAPT. What additional medication should be started and for what reason?
PPI to decrease risk of upper GIB
Prior to starting biologic DMARD for rheumatoid arthritis, what should be screened for?
TB, Hep B and C
another name for anti Scl-70 antibodies?
antitopoisomerase antibodies
Warfarin is the preferred AC for atrial fibrillation for which criteria?
severe mitral stenosis (less than or equal to 1.5cm2), any mechanical heart valves
Patient is found to have CNS toxoplasmosis. They are started on treatment with sulfadiazine and pyrimethamine. What additional medication should be started?
leucovorin
Acute neck pain that develops after administration of IV metoclopramide. Most likely diagnosis and most appropriate treatment option?
medication induced dystonia
Treat with anticholinergic, or agent with both anticholinergic and antihistamine (diphenhydramine)
Patient has concerns for meningitis on physical exam. They have not undergone CT of head yet. What should be done prior to LP?
empiric antibiotics and corticosteroids
In order to prevent recurrent calcium urinary stones, other than increasing PO fluid intake to keep >2L of urine output per day, what should be done?
Decrease sodium and protein intake. Increase potassium and citrate intake
Most common cause of erythropoietin resistance in patients with ESRD?
iron deficiency
How long should you stay on antidepressant before coming off? what if there is recurrent depressive episodes?
for at least 6 months
if recurrent 1-3 years
acetazolamide causes what type of metabolic acidosis?
non-anion gap
other than lowering respiratory rate and increasing sedation, what can be done with vent settings to help fix respiratory alkalosis?
decrease tidal volume
Rebleeding is the major cause of death within the first 24 hours of presentation of subarachnoid hemorrhage. What should be done to best stabilize bleeding?
conventional angiogram for endovascular intervention (coiling vs stenting)
most common organisms are associated with tattooing process?
staph
In patient with HIV and CD4 counts less than 100, what ppx should be given?
Bactrim for both PJP and toxo
Histo ppx should only be considered for those living in endemic areas and is not required
Patient with anal fissure that does not resolve with conservative management should undergo what next step in management?
colonoscopy to screen for Crohn disease
Patient has no complaints. EKG shows QT interval of 505 msec. FH of paternal aunt died unexpectedly at 32. Most likely diagnosis and appropriate treatment step?
congenital long QT syndrome
beta blocker
which drug that is overdosed on is most commonly associated with serotonin syndrome, severe hyperthermia, and hyponatremia?
NMDA (3,4-methylenedioxymethamphetamine)
post menopausal women with significant menopausal symptoms. She has history of VTE. What is most appropriate step in management?
give nonhormonal therapy which is SSRI
Patient who was originally admitted for induction for chemotherapy who develops new onset renal failure. Most likely diagnosis? Next best step in treatment?
tumor lysis syndrome
aggressive hydration and rasburicase. If still not improving, consider renal replacement therapy
Patient with new onset confusion, agitation, ataxia, and neuromuscular excitability is consistent with what diagnosis?
acute lithium toxicity
what can cause an elevated ABI result?
calcified vasculature that can be indicative of peripheral artery disease
Patient with REM sleep behavior disorder (dream-enacting behaviors such as talking, yelling, punching, kicking) can be an early sign what disease?
parkinson disease
Patient with concerns for syncopal episodes, primarily in the morning when getting dressed, orthostatics are negative, EKG is normal. Most likely cause?
carotid sinus hypersensitivity
Patient with concerns for PAD. undergoes ABI which is normal. Next best step in management?
exercise testing with repeat ABI
Encephalitis associated with acute asymmetric flaccid paralysis or extrapyramidal symptoms is highly suggestive of what infection?
West Nile virus infection
Patient is found to have acute hepatitis A infection, confirmed on hepatitis panel. What should be recommended to healthy family members that live in the same household?
administer HAV vaccine to all household contacts
any patient that has new-onset COPD/emphysema at age <45 with minimal smoking history should undergo what testing?
alpha-1 antitrypsin levels
Elderly patients with silent, chronic lacunar infarcts are at increased risk of developing what condition?
dementia
Male patient that is found to have osteoporosis should undergo what testing?
testosterone levels
Liver biopsy that shows onion skin fibrosis is consistent with what diagnosis? What should also be done for patients with this diagnosis?
primary sclerosing cholangitis
undergo colonoscopy for evaluated for IBD and then colon cancer screening
Celiac disease is associated with hyposplenism. Patients with celiac disease should therefore undergo what vaccinations?
pneumococcal vaccine
patient with poor PO intake, gingival swelling and bleeding, and petechiae with lower platelet count is concerning for what diagnosis?
vitamin C deficiency, scurvy
In patient with recurrent uncomplicated UTIs, what is the next best step in management?
prophylactic antibiotics
(over urologic evaluation when uncomplicated)
Elevated IGF-1 levels is consistent with what diagnosis?
What is the patient at highest risk of developing if left untreated?
acromegaly
Colonic neoplasia
In an immunocompetent patient that is found to have candida species grown on sputum culture, what is the next best step in management?
no antifungal treatment needed unless they are immunocompromised
Which antibody is associated with autoimmune hepatitis?
anti-smooth muscle antibody
anti-liver/kidney microsomal antibody (LKM-1)
Patient with jaw claudication, “curtain falling in front of one eye”, elevated ESR. Most concerning diagnosis? Treatment?
giant cell arteritis
steroids
Patient presents with right thigh pain, with exam showing a tender, nodular cord in that area. Most likely diagnosis? next best step in management?
superficial vein thrombophlebitis
screen for DVT with ultrasound doppler
Patient with smooth, circular patch of non-scarring hair loss is most likely what diagnosis? Treatment?
alopecia areata
intralesional corticosteroid
Patient that is on methotrexate should be alerted of toxicities that are associated with lowering what metabolite?
folic acid
Prolactin level of what, usually indicates prolactinoma? Diagnosis is confirmed with what test? First line treatment?
> 200 ng/ml
MRI of head
Dopamine agonist (cabergoline, bromocriptine)
What is the most common cause of unexpected mortality in patients undergoing cardiac catheterization?
retroperitoneal hemorrhage
(resulting from arterial puncture above the inguinal ligament)
EKG strip with rate >100, >3 different P wave morphologies, and irregular R-R intervals is indicative of what tachyarrhythmia? Usually is associated with what disease process?
multifocal atrial tachycardia
COPD exacerbation
Patient with foreign tropical travel and disease. Notably in exam, patient has conjunctival redness with no drainage. Most likely cause?
leptospirosis
Diagnostic approach to peripheral neuropathy should include what, when patient has normocytic anemia and hypercalcemia?
serum protein electrophoresis
African American patient that has hematuria as well as dilute urine. What diagnosis should be considered? Which test can confirm this diagnosis?
sickle cell trait
hemoglobin electrophoresis
Patient started on amiodarone who develops fatigue, lethargy. Concern to think of? next best step in management?
thyroid dysfunction in long term amiodarone usage
Should continue amiodarone and start levothyroxine
Patient who is immunocompromised that has pneumonia. LDH is greater than 450. Most likely diagnosis?
PJP pneumonia
Patient with worsening involuntary contractions, has been on immediate release carbidopa/levodopa for the last 5 years for Parkinson disease. Most likely diagnosis? Next best step in management of patient’s current symptoms?
dystonia, secondary to insufficient dopamine in CNS
Switch to extended release version of carbidopa/levodopa
Patient that has history of gastric bypass surgery who comes in with imbalance, fatigue, anemia, peripheral neuropathy. Vitamin B12 levels are normal. Next best step in management?
check copper levels
low copper can mimic low vitamin B12
Scleroderma renal crisis should be managed with which type of antihypertensive?
ACE inhibitor
In patient with AIDS, you see ring-enhancing lesions in the CNS. Most likely suggestive of what two diagnoses? How to differentiate?
primary central nervous system lymphoma or toxoplasma encephalitis
PCNSL is typically solitary lesions, >4 cm, and involve corpus callosum, periventricular or periependymal areas
Toxo is multiple lesions, and involves basal ganglia
Patient with meningococcal meningitis. What precautions should be used?
droplet (wearing mask in vicinity of patient) precautions for at least 24 hours after start of antibiotics
Patient with history of asthma or cystic fibrosis who has elevated IgE levels, and chest xray with patchy infiltrates. Most likely diagnosis? Treatment?
allergic bronchopulmonary aspergillosis
Steroids and itraconazole
When patient has close contact with active TB patient, initial TB skin testing reveals induration to 2mm and no symptoms. Next best step in management?
repeat skin testing in 8-12 weeks
At what size of kidney stone should urology be involved for stone removal, even if no signs of infection, kidney failure or complete obstruction?
> 10mm
younger female with amenorrhea, symptoms of menopause, and elevated FSH and low estradiol is indicative of what diagnosis?
primary ovarian insufficiency
Which criteria would you want a higher INR level goal (2.5-3.5)?
mitral valve replacement
aortic valve replacement and at least one risk factor (a fib, LV systolic dysfunction, prior VTE, hypercoagulable state)
What can be seen in conjunction with papillary muscle rupture post MI that causes sudden onset hypotension and pulmonary edema?
acute mitral regurgitation
Patient is found to have lithium induced diabetes insipidus. They are unable to come off of lithium due to need for control of bipolar. Next best step in management?
salt restriction and diuretic therapy (amiloride or thiazides)
Which congenital cardiac defect is most commonly associated with coarctation of the aorta?
bicuspid aortic valve
In a patient with acute pericarditis, initial EKG findings are diffuse ST segment elevation. In the next several days, you would see what finding?
diffuse T wave inversions
Best agent to help treat depressed elderly patients with anxiety, insomnia, and weight loss?
mirtazapine
First line treatment for lung abscesses?
IV ampicillin-sulbactam
No need for drainage
In patients that have incidental pituitary adenoma, what is next best step in evaluation? What if it measures >10mm or less than 10mm?
If between 5-9mm, would just need prolactin levels only
if >10mm, need visual acuity testing in addition to prolactin levels
At what level should you assuredly have EKG changes in hyperkalemia. If you do not see this, what diagnosis should you consider?
> 8mEq/L
pseudohyperkalemia and should recheck arterial K level
Woman aged >30 who has palpable breast mass but no findings on imaging. Otherwise no other symptoms or complaints. What is next best step in management?
core needle biopsy to exclude malignancy
Patient that has history of renal transplant presents with worsening AKI. Urine analysis with cytology shows intranuclear inclusions. Most likely diagnosis?
Polyomavirus-induced nephropathy (BK virus)
