UWorld 2 Flashcards
Findings in Meniere disease?
Recurrent episodes
Unilateral hearing loss and tinnitus
Feeling of fullness in the ear
Findings in BPPV?
Brief episodes triggered by head movement
Dix-Halpike maneuver causes nystagmus
Findings in vestibular neuritis?
Acute, single episode that can last for days
Often follows viral syndrome
Abnormal head thrust test
Findings of vertigo in migraine?
Vertigo associated with headache or other migrainous phenomena (auras, eg)
Symptoms resolve completely between episodes
Findings of vertigo in a brainstem or cerebellar stroke?
Sudden onset, persistent vertigo
Usually other neurologic signs
What arteries are affected in fibromuscular dysplasia?
Renal
Internal Carotid
Vertebral, iliac, and mesenteric arteries are less commonly affected.
Presentation of dermatitis herpetiformis
Group pruritic vesicles on the buttocks and extensor surfaces. Occurs with autoimmune dermal reaction to dietary gluten. IgA antibodies to epidermal translutaminase
Clinical features and treatment of cocaine use?
Sympathetic hyperactivity: tachycardia, hypertension, dilated pupils. Agitation, seizures, chest pain 2/2 coronary vasoconstriction
Benzodiazepines (BP/anxiety), aspirin, Nitroglycerin and CCB for pain. Cardia catheterization if indicated. No fibinolytics, and beta blockers contraindicated
Statins are recommended for what populations regardless of other risk factors?
Clinically significant atherosclerotic disease (ACS, MI, Stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, PAD)
Patients age 40-75 with Diabetes
LDL over 190
Estimated 10 year ASCVD ask over 7.5%
Malaria prophylaxis?
Mefloquine chemoprophylaxis starting 2 weeks before and extending 4 weeks after returning.
Atovaquone-proguanil and doxycycline may also be used
What is electrical alternans?
Variable amplitude QRS complexes that may be seen in pericardial effusion, likely due to heart moving back and forth in pericardial fluid
Membranoproliferative glomerulonephritis pathogenesis
Deposition of C3 complexes that result from IgG antibodies to C3 convertase of the alternative complement pathway.
Chromium deficiency
Impaired glucose control in diabetics
Copper deficiency
Brittle hair Skin depigmentation Neurologic dysfunction/ataxia Sideroblastic anemia Osteoporosis
Selenium deficiency
Thyroid dysfunction
Cardiomyopathy
Immune dysfunction
Zinc deficiency
Alopecia Pustular skin rash Hypogonadism Impaired wound healing Impaired taste Immune dysfunction
Cardiac selective beta blockers?
Metoprolol
Atenolol
Bisoprolol
Nebivolol
Can still trigger asthma when administered in large doses
Presentation and Tx of acute adrenal insufficiency?
Hypotension, tachycardia, abdominal pain, vomiting and weakness.
Tx: IVF and dexamethasone
Presentation and Tx of thyroid storm?
Fever to 104-106
Tachycardia, hypertension, cognitive heart failure, cardiac arrhythmias
Agitation, delirium, coma, seizures
Goiter, lid lag, tremor, warm and moist skin,
Nausea, vomiting, diarrhea, jaundice
Tx: Beta-blocker, PTU, corticosteroids, ID and treat trigger
Clinical associations of focal segmental glomerulonephritis?
African american and hispanics
Obesity
HIV
Heroin use
Clinical associations of membranous nephropathy?
Adenocarcinoma (breast, lung)
NSAIDs
Hep B
SLE
Clinical associations of membranoproliferative glomerulonephritis?
Hep B
Hep C
Lipodystrophy
Clinical associations of minimal change disease?
NSAIDs
Lymphoma
Clinical associations of IgA nephropathy?
URI
Causes of myopathy?
Connective tissue disease (poly/dermato-myositis, vasculitis)
Endocrine/metabolic (hypothyroid, thyrotoxicosis, cushing, e-lyte abnormalities)
Drugs/Toxins (corticosteroids, zidovudine, colchicine, alcohol cocaine)
Misc (infections, trauma, hyperthermia)
Norcardiosis
Gram positive, branching or beaded appearance, partially acid-fast, aerobic.
Infects the elderly or immunosuppressed via inhalation or cutaneous penetration (while gardening)
TB-like pneumonia, brain abscess, cutaneous involvement
TMP-SMX and drainage of abscesses
Differentiate viral arthritis 2/2 parvovirus B19 from RA and SLE
Parvovirus may have weakly positive RA factor and ANA antibodies, but is more common than RA or SLE.
RA and SLE typically produce a more prominent synovitis and follow a more protracted course, SLE also may show renal involvement.
B19 infection causes fevers and a temporary polyarthritis that spontaneously resolves and does not cause renal damage.
Furunculosis vs hidradenitis supporativa
A furuncle is a skin abscess commonly caused by Staph aureus, presenting as a painful pustule or nodule typically draining purulent material.
HS occurs in intertriginous areas (or any area with hair), due to chronic inflammatory occlusion of the folliculopilosebaceous units preventing keratinocytes from shedding from the epithelium. Typically causes inflamed nodules that may drain supportive fluid.
Differentiate Mobitz I from Mobitz II
Mobitz I - Blockage at the AV node, Progressive elongation of PR until there is a dropped beat. Exercise and atropine improve Mobitz I, vagal maneuvers worsen it.
Mobitz II - Blockage below the AV node in bundle of His, no change in PR, occasional dropped beat. QRS may be narrow or wide, Exercise or atropine worsens type II block, Vagal maneuver improves type II. Higher risk of complete block, indication for pacemaker placement.
Diagnostic requirements for acute liver failure?
Severe acute liver injury (AST, ALT above 1000)
Signs of hepatic encephalopathy (confusion, asterixis)
Synthetic liver dysfunction (INR above 1.5)
Signs of disseminated gonococcal infection?
Polyarthralgia
Skin lesions
Tenosynovitis
Not associated with morning stiffness, oral ulcers, or glomerulonephritis (these point toward SLE).
Cryptosporidium vs CMV vs MAC in HIV patients?
Crypto: High volume watery diarrhea, low fever
MAC: High Volume watery diarrhea, HIGH fever
CMV: Low volume bloody diarrhea, low fever
Digitalis toxicity cause what kind of heart abnormality?
Atrial tachycardia with AV block. Increases ectopy in the atria causing more frequent contractions, but not a-fib.
Signs of bradyarrhythmia in a syncopal patient?
Prolonged PR and QRS, sinus pauses
Also seen in sick sinus syndrome and AV block
Presentation of sarcoidosis?
Constitutional symptoms Cough dyspnea and chest pain Extra pulmonary findings - Skin lesions - Anterior/posterior uveitis - Lofgren syndrome
Young adults and african americans
Non-caseating granulomas that are negative for bacteria and fungi
Precipitating factors for hepatic encephalopathy?
Drugs (sedatives, narcotics) Hypovolemia (diarrhea) Electrolyte changes (hypokalemia) Inc nitrogen load (BUN, Gi bleeding) Infection (pneumonia, UTI, SBP) Portosystemic shunting (TIPS)
Clinical presentation and treatment of hepatic encephalopathy?
Sleep pattern changes, altered mental status, asterixis, ataxia
Correct precipitating causes (fluids, e-lytes, antibiotics, etc)
Decrease blood ammonia concentration (lactulose, rifaximin)
Major side effect of fluoroquinolones? risk factors?
Tendinopathy and increased risk of tendon rupture (most commonly achilles, also rotator cuff, hand, biceps, thumb, and others)
Age over 60 Female Normal BMI Concurrent oral steroid use Organ transplant
How does sodium bicarbonate resolve TCA overdose? Aspirin overdose?
TCA: TCAs bind to fast sodium channels in the His-Purkinje system and myocardium. NaHCO increases the concentration of Na to compete for these channels and the HCO3 raises the pH which lowers TCA affinity for the channels.
Aspirin: NaHCO alkalinizes the urine, increasing the excretion of aspirin.
Lung cancer screening guidelines for smokers?
Annual low-dose chest CT for:
Age 55-80
30+ pack year smoking history
Currently smoking or quit within past 15 years
Sputum cytology does not effectively screen for cancer and does not improve mortality. Don’t use it.
Causes of acute pancreatitis other than alcohol and gall stones?
Hypertriglyceridemia (1,000+, yellow-red skin papules may represent familial HLD)
Drugs (azathioprine, valproic acid, thiazides)
Infections (CMV, Legionella, Aspergillus)
Iatrogenic (Post-ERCP, ischemic/atheroembolic)
Clinical features and testing for chronic autoimmune thyroiditis?
Hashimoto’s thyroiditis
Predominant hypothyroid features
Diffuse goiter
Tests: TPO antibody positive, variable radioiodine uptake
Clinical features and testing for painless thyroiditis?
Silent thyroiditis (Variant of chronic autoimmune thyroiditis) Mild, brief hyperthyroid phase, Small, non-tender goiter, spontaneous recovery
Postive TPO antibody, Low radio iodine uptake
Clinical features and testing for subacute thyroiditis?
DeQuervain’s Thyroiditis
Likely post-viral inflammatory process, Prominent fever and hyperthyroid symptoms, Painful, tender goiter (think deQuervains tendonitis)
Elevated ESR and CRP (inflammatory), low radio-iodine uptake
Antidote for organophosphate poisoning?
Atropine - competes with acetylcholine at muscarinic receptors and blocks its effect
OP block ACh-esterase overload and the NMJ with ACh. Physostigmine is an acetylcholinesterase inhibitor and worsens this condition.
