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STEP 3 > UWorld 2 > Flashcards

UWorld 2 Flashcards

0
Q

What is the initial management of diabetic ketoacidosis (DKA)?

A

– IV insulin as well as normal saline, with potassium added for patients with a serum potassium of less than 5.3 mEq/L (IV insulin should be continued until the anion gap has resolved)
– If serum glucose falls below 200 mg/dL, but the patient still has an elevated anion gap
– The rate of insulin infusion should be halved and the IV fluid should be converted to D5 half normal saline, to prevent hypoglycemia

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1
Q

What is the equation for anion gap?

A

[Serum Na - (serum Cl + serum bicarbonate)]

– Normal range from 7-13

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2
Q

What is the criteria for resolution of diabetic ketoacidosis (DKK)?

A

– Serum glucose of < 200 mg/dL
– Anion gap <12 mEq/L
– Serum bicarbonate of at least 18 mEq/L
– Ability to eat

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3
Q

What is the insulin regimen once diabetic ketoacidosis (DKA) has been resolved?

A

Patient should be started on subcutaneous insulin
– IV insulin infusion should be continued for about two hours after subcutaneous insulin is started in order to give subcutaneous insulin time to take effect and prevent rebound ketoacidosis

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4
Q

What is the treatment of clavicular fractures?

A

Displaced fractures
– Usually require open reduction and internal fixation
Nondisplaced fractures
– ice, analgesics, double range of motion exercises, and either a sling or figure of eight bandage

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5
Q

What is the treatment of breast milk jaundice?

A

– Continue breast-feeding exclusively

– Jaundice should resolve spontaneously by age 3 months

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6
Q

What is the T-score BMD scale?

A

Normal (T-score >1.0)
Osteopenic (T-score between -1.0 and -2.5)
Osteoporosis (T-score <-2.5)

This is the BMD score of a patient in comparison to young healthy adults around 25-30 years of age

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7
Q

What are the major risk factors for fragility fractures?

A 
– Low bone density
– History of fragility fractures
– Family history of osteoporosis
– Current smoking
– Bodyweight less than 127 pounds
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8
Q

What is ecologic fallacy?

A

A study bias where population level information is applied to an individual level

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9
Q

What is the initial management in diagnosing dementia?

A

Ruling out reversible causes of cognitive decline

– Check for hypothyroidism and B12 deficiency

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10
Q

How do you confirm the eradication of H. pylori infection?

A

Either urea breath or fecal antigen testing

– Must be performed at least 4 weeks AFTER completion of therapy

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11
Q

What cutaneous manifestation is a well-known phenomenon in patients with infectious mononucleosis?

A

Ampicillin-associated maculopapular rash

– Vasculitic immune-mediated rash, caused by circulating IgG and IgM antibodies toward penicillin derivatives

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12
Q

What is the treatment for infectious mononucleosis?

A

Supportive and observation

– Acetaminophen and NSAIDs for fever, throat pain, and malaise, as well as adequate nutrition, fluids, and rest

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13
Q

Describe Cushing’s Triad

A

– Intracranial hypertension

  1. Bradycardia
  2. Hypertension
  3. Respiratory depression
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14
Q

What are the contraindications to lowering the PaCO2 by hyperventilating the patient?

A

– Traumatic brain injury

– Acute stroke

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15
Q

What is the maximum blood pressure permitted in patients with acute ischemic stroke who do not receive thrombolytic therapy?

A

220/120 mmHg

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16
Q

What is the relationship between cellulitis and local anesthetics?

A

Local anesthetics are not effective for managing cellulitis pain because the acidic environment of the infection neutralizes the basic medication, rendering ineffective

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17
Q

What laboratory values are you expected to see in Paget’s disease of the bone?

A

Elevated alkaline phosphatase and a normal calcium level

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18
Q

Describe the management of hip fractures

A

Surgery and pain control
– Patients who are ambulatory and stable
Non-operative
– Patients who are non-ambulatory, have advanced dementia, or are unstable with many comorbidities

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19
Q

What is the proposed treatment for H. pylori infection?

A

Triple therapy for 2 weeks
– Proton pump inhibitor
– Amoxicillin
– Clarithromycin

Metronidazole can be substituted for amoxicillin in penicillin-allergic patients

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20
Q

What is the treatment for persistent H. pylori infection?

A

Quadruple therapy
– Proton pump inhibitor
– Bismuth-based triple therapy (bismuth, tetracycline, and metronidazole)

21
Q

Describe the clinical presentation of condylomata acuminata

A

 Pruritus, bleeding, burning, tenderness, vaginal discharge and pain
Large lesions can interfere with:
– Defecation, vaginal intercourse, and delivery
Small lesions:
– Frequently accidental findings on physical exam or can be minimally symptomatic

22
Q

What is the treatment for a condyloma acuminatum?

A

Chemical destruction is the preferred initial approach

– Trichloracetic acid application destroys the lesion by protein coagulation

23
Q

What is the most common cause of viral meningitis or encephalitis in the pediatric population?

A

Enterovirus or Arbovirus

24
Q

What states do NPH or glargine insulin cover?

A

These are basal insulin and are required to cover the period between meals

25
Q

Describe the pathophysiology of pioglitazone

A

– Increases insulin sensitivity

– And oral hypoglycemic agent from the thiazolidinedione (glitazone) group

26
Q

What is the pathophysiology of glyburide?

A

– Increases insulin production from beta cells

– Oral hypoglycemic agent (sulfonylurea)

27
Q

Describe acute mesenteric ischemia

A

– Sudden onset of periumbilical abdominal pain
– Pain usually out of proportion to initial physical exam
– Abdominal exam is initially normal

28
Q

What are the diagnostic tests for acute mesenteric ischemia?

A

– Metabolic acidosis (elevated lactic acid)
– Elevated amylase level
– Most accurate test: angiography

29
Q

What is the treatment of acute mesenteric ischemia?

A

Surgical resection of the bowel

30
Q

What are the complications of diphtheria antitoxin?

A 
– Myocarditis
– Neuritis
– Nephritis (rarely)
– Anaphylaxis
– Hypersensitivity or serum sickness (because it's made with horse serum)
31
Q

What does estrogen do to thyroid levels?

A

– Increase thyroid binding globulin (TBG)

– Decrease free T4

32
Q

What drugs increase TBG?

A

– Estrogen
– Tamoxifen
– Raloxifen
– Methadone, heroin

33
Q

What are drugs that decrease TBG?

A

– Androgens
– Danazol
– Anabolic steroids
– Glucocorticoids

34
Q

What changes are seen in arterial systolic blood pressure with inspiration?

A

It normally drops 10 to 12 mmHg

35
Q

What is Beck’s Triad?

A

Classic presentation of cardiac tapenade

  1. Hypotension
  2. Muffled or distant heart sounds
  3. Elevated jugular venous pressure
36
Q

What is the correlation between egg allergy and influenza vaccine?

A

Anaphylaxis to egg:
– NO vaccine (immediate-type hypersensitivity rxn)
Urticarial reaction to egg:
– ONLY IM vaccine followed by >/= 30 minutes of observation

37
Q

How do you diagnose carpal tunnel syndrome?

A 
Phalen's sign
– Hyperflexion of the wrist
Tinel's sign
– Tapping over the median nerve
Hand elevation
– Hand above the head reproduces symptoms
38
Q

How do you confirm the diagnosis of carpal tunnel syndrome?

A

Nerve conduction studies
– Slowed conduction along median nerve
– Normal conduction velocity proximal to carpal tunnel
– Frequently combined with electromyography (EMG)

39
Q

What is the treatment of carpal tunnel syndrome?

A

Nighttime splinting
– First-line for patients with mild to moderate symptoms for <10 months
Injected or oral corticosteroids
– Patients who do not improve with splinting
Surgical decompression
– Patients who failed conservative management with mod-severe symptoms for at least 6 months

40
Q

What is the presentation of primary biliary cirrhosis (PBC)?

A

– Middle aged woman
– Itching
– Xanthelasmas
– History of other autoimmune disorders

41
Q

What are the diagnostic tests for primary biliary cirrhosis (PBC)?

A 
Best initial test:
   – Elevated alkaline phosphatase
   – Normal bilirubin
   – IgM elevated
Most accurate test:
   – Antimitochondrial antibody (AMA)
   – Liver biopsy
42
Q

What is the treatment for primary biliary cirrhosis?

A

Slows progression and improves overall survival
– Ursodeoxycholic acid
The only curative treatment:
– Liver transplantation

43
Q

Patients with primary biliary cirrhosis are at high risk for developing what complication?

A

Osteomalacia osteoporosis

44
Q

What is the treatment of graves disease?

A

Preferred definitive therapy: Radioactive iodine

– Concurrent use of prednisone in patients with mild ophthalmopathy

45
Q

How do you assess thyroid function after radioactive iodine treatment?

A

Measure total T3 and free T4 levels

46
Q

What is the classic pentad for thrombotic thrombocytopenic purpura?

A
  1. Severe thrombocytopenia
  2. Microangiopathic hemolytic anemia (RBC fragments)
  3. Fluctuating neurologic signs
  4. Renal failure
  5. Fever
47
Q

Which UTI antibiotics are recommended in pregnancy?

A

– Nitrofurantoin
– Amoxicillin
– Amoxicillin-calvulanate
– Cephalexin

48
Q

Which antibiotics are contraindicated in pregnancy?

A

– Tetracyclines
– Fluoroquinolones
– Trimethoprim sulfamethoxazole

49
Q

What is the presentation of carbon monoxide poisoning?

A

Throbbing headache, nausea, malaise, and dizziness

STEP 3 (6 decks)

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