UWorld 2 Flashcards
1
Q
Ehrlichiosis
A
- in a pt from endemic region with a h/o tick bites, febrile illness with systemic symptoms, leukopenia, and/or thrombocytopenia, an elevated aminotransferases
- drug of choice: doxy
2
Q
thyroid lymphoma
A
- uncommon, but incidence is 60x greater in pts with preexisting chronic lymphocytic (Hashimoto) thyroiditis
- typical presentation: rapidly enlarging, firm goiter associated with compressive s/s (dysphagia, hoarseness) and systemic B symptoms (fever, night sweats, weight loss)
also: retrosternal extension=distended neck veins and facial plethora; raising arms causes compression of subclavian and r. internal jugular bein
3
Q
disseminated gonococcal infection
A
-triad: polyarthralgias, tenosynovitis, vesiculopustular skin lesions
4
Q
pts with carotid artery stenosis
A
should all receive medical therapy with antiplatelet agents and statins
- some evidence for benefit of carotid endarterectomy in asymptomatic pts with high grade (80-99%) stenosis
- asymtpomatic pts with lower grade (<80%) lesions are managed medically
5
Q
retinal detachment
A
cp: sudden onset of photopsia and floaters; “a curtain coming down over my eyes”
6
Q
MEN1
A
-primary hyperparathyroidism (hypercalcemia), pituitary tumors (prolactin, visual defects), pancreatic tumors (especially gastrinomas)
7
Q
MEN 2A
A
-MTC (calcitonin), pheochromocytoma, parathyroid hyperplasia
8
Q
MEN 2B
A
-MTC (Calcitonin), pheochromocytoma, mucosal neuromas/marfinoid habitus
9
Q
age related macular degeneration
A
- in pts >50yo
- cp: progressive and b/l l/o ctl vision; navigational vision is preserved
10
Q
predisposing conditions for aspiration PNA
A
- altered consciousness impairing cough reflex/glottic closure (dementia, drug intoxication)
- dysphagia d/t neurologic deficits (stroke, neurodegenerative dz)
- upper GI tract d/o (GERD)
- mechanical compromise of aspiration defenses (nasogastric and endotracheal tubes)
- protracted vomiting
- large-volume tube feedings in recumbent position
11
Q
AML
A
-m/c adult leukemia, median age 65
manifestations:
- fatigue is common
- often presents with symptoms from cytopenias: fatigue, weakness (anemia); bleeding, bruising (thrombocytopenia); infection (granulocytopenia)
- DIC (if APML)
- hepatosplenomegaly/LAD are rare
12
Q
hereditary telangiectasia (Osler-Weber-Rendu syndrome)
A
- can develop pulmonary AVMs associated with hemoptysis and R-to-L shunt physiology
- cp: pt with recurrent nose bleeds and oral lesions
13
Q
infectious mono
A
-EBV is m/c etiology
clinical ft:
- fever
- tonsillitis/pharyngitis +/- exudates
- posterior or diffuse cervical LAD
- significant fatigue
- +/- hepatosplenomegaly
- +/-rash after amoxicillin
diagnostic findings:
- positive heterophile Ab (monospot) test (25% false-negative rate d/r first wk of illness)
- atypical lymphocytosis
- transient hepatitis
management: avoid sports for >/=3 weeks (contact sports >/=4 wks) d/t r/o splenic rupture
14
Q
multiple myeloma
A
- plasma cell neoplasm that infiltrates the bone marrow and may cause a monoclonal protein elevation (M-spike)
- associated with hypercalcemia, anemia, renal insufficiency, and an elevated protein gap (>4 g/dL)
15
Q
CHA2DS2-VASc score >/=2
A
-warfarin or non-vitamin K antagonist oral anticoagulants (apixaban, dabigatran, rivaroxaban) should be used to reduce r/o systemic thromboembolism in pts with afib and moderate to high r/o thromboembolic events
16
Q
clinical presentation of alcoholic hepatitis
A
- jaundice, anorexia, fever
- RUQ and/or epigastric pain
- abdominal distension d.t ascites
- proximal muscle weakness f/m muscle wasting (if malnourished)
- possible hepatic encephalopathy
17
Q
lab/imaging studies of alcoholic hepatitis
A
- elevated AST and ALT, usually <300U/L
- AST:ALT ratio >/=2
- elevated ggt, bili, and/or INR
- leukocytosis, predom neutrophils
- dec albumin if malnourished
- abdominal imaging may show fatty liver
18
Q
dietary recs for pts with renal calculi
A
- inc fluid intake
- dec sodium intake
- nml dietary calcium intake
19
Q
recommended vaccines for chronic liver dz
A
- Tdap/Td q10y
- influenza annually
- PPSV23 once then revaccination with sequential PCV13 and PPSV23 at age 65
- Hep A: two doses six months apart with initial negative serologies
- Hep B: 3 doses at 0 months, 1 month, and at least 4 months with initial negative serologies
20
Q
clinical findings of acute opioid intoxication
A
- somnolence, AMS
- pinpoint pupils (miosis)
- shallow breathing and dec RR
- bradycardia, hypothermia, dec bowel sounds
- resp acidosis on ABG
21
Q
management for acute opioid intoxication
A
- NALOXONE (may need repeated dosings)
- AW management and ventilation
- exclude other AMS causes (hypoglycemia)
22
Q
succesful randomization in a clinical trial
A
allows a study to eliminate bias in tx assignments
-ideal randomization process minimizes selection bias, results in near-equal treatment and control group sizes, and achieves a low probability of confounding variables
23
Q
external hordeolum
A
- acute inflammatory d/o of the eyelash follicle or tear gland and presents as an erythematous, tender nodule at the lid margin
- often d/t infection with S. aureus but can be sterile
- initial tx: warm compresses
24
Q
progressive multifocal leukoencephalopathy (PML JC)
A
epi: JC virus reactivation, sever immunosuppression (untreated AIDS)
manifestations: slowly progressive, confusion, paresis, ataxia, sz
diagnosis: CT brain (white matter lesions with no enhancement/edema); LP (CSF PCR for JC virus); brain bx rarely needed
tx: often fatal, if HIV-retroviral therapy
25
ascites
- most commonly caused by cirrhosis d/t alocholic liver dz or chronic viral hepatitis
- all pts with new-onset ascites require paracentesis to determine the cause
26
membranous nephropathy
-m/c form of nephrotic syndrome associated with carcinoma
27
small cell carcinoma of the lung
usually causes other paraneoplastic syndromes such as ACTH production and SIADH
28
etiology of prerenal acute kidney injury
decreased renal perfusion
- true volume depletion
- dec EABV (HF, cirrhosis)
- displacement of intravascular fluid (eg sepsis, pancreatitis)
- renal artery stenosis
- afferent arteriole vasoconstriction (eg NSAIDs)
29
clinical features of prerenal acute kidney injury
- inc in serum cr (50% from baseline)
- dec urine output
- BUN/Cr ration >20:1
- FeNa <1%
- unremarkable ("bland") urine sediment
tx: restoration of renal perfusion
30
disseminated gonococcal infection
CPL purulent monoarthritis AND/OR triad of: tenosynovitis, dermatitis (erythematous papules and pustules), asymmetric migratory polyarthralgias
diagnosis: blood cultures (may be negative), synovial fluid analysis: inflammatory effusion with neutrophil predominance, gram stain and culture or NAAT; culture or NAAT of urethre, cervix, pharynx, rectum
tx: IV ceftriaxone, switch to oral (cefixime) when clinically improved; empiric azithro OR doxy for concomitant chlamydial infection; jt drainage for purulent arthritis
31
acute gout
presents as an acute monoarthritis, usually in first metatarsophalangeal jt or knee
-synovial fluid analysis: leukocytosis (2k-10k with >50% neutrophils) and MONOSODIUM URATE crystals (needle shaped and negatively birefringent)
-vs-
calcium pyrophosphate dihydrate deposition (CPPD) which causes pseudogout; smaller rhomboid-shaped and weakly positively birefringent
32
m.c c/o urinary retention in elderly males
-enlarged prostate which is usually revealed by rectal exa, and characterized by high postvoid residual volume
33
inflammatory bowel dz
- frequently complicated by arthritis which occurs in up to 45% of pts and can involve axial or peripheral jts
- NSAIDs may exacerbate the underlying dz
34
clinical presentation of asbestosis ( an pneumoconiosis form particle inhalation)
- prolonged asbestos exposure (shipyard, mining)
- s/s develop >/=20yrs after initial exposure
- progressive dyspnea, basilar fine crackles, clubbing
- inc risk for lung ca and mesothelioma
35
diagnostic eval of asbestosis
- pleural plaques on chest imaging
| - imaging, PFT (shows restrictive lung dz) and histology consistent with pulmonary fibrosis
36
presbyopia
common age-related decrease in lense elasticity that leads to difficulty with near vision
-h/o of a middle ages indiv who has to hold books at an arms length=classic cp
37
toxic megacolon
- cp: total or segmented nonobstructive colonic dilation, severe bloody diarrhea, systemic findings (tachy, fever)
- pts with inflamm bowel dz are at higher r/o developping toxic megacolon
- diagnosis: confirmed by plain abdo xrays and >/=3 of: fever >38 C (100.4F), pulse >120/min, WBC ct>10.5k and anemia
- medical emergency that requires prompt iv steroids, nasogastric decompression, Abx and fluid management
38
nasal polyps
- often associated with chronic rhinosinusitis, asthma, and ASA- or NSAID-induced bronchospasm in ASA-exacerbated respiratory dz
- they frequently cause symptoms of b/l nasal obstruction, nasal d/c and anosmia
39
presbycusis
- sensorineural hearing loss that occurs with aging
- usually first noticed in 60s and presents with high-frequency, b/l hearing losee
- pts often have difficulty hearing in noisy, crowded environments
40
hypertensive urgency vs emergency
urgency: severe HTN (usually >/=180/20 mm Hg) with no s/s of acute end-organ damage
emergency: severe HTN with acute, life-threatening, end-organ complications
- malignant HTN: severe HTN with retinal hemorrhages, exudates, or papilledema
- hypertensive encephalopathy: severe HTN with cerebral edema and non-localizing neurologic s/s
41
COPD pts
who have a resting arterial oxygen tension (PaO2) =55 mm Hg or pulse ox saturation (SaO2) =88% are candidates for long-term home oxygen tx
-those with signs of RHF or HCt >55% should be started on home oxygen of PaO2=59mmHg or SaO2=89%
42
Trastuzumab
- used for tx of pts with human epidermal growth receptor 2-positive breast carcinoma
- associated with r/o cardiotoxicity
- cardiac fxn should be assessed with echocardiography at baseline and at regular intervals in pts treated with Trastuzumab
43
hypokalemia
can be caused by increase intracellular entry of potassium (eg with insulin, beta-adrenergic agents, hematopoiesis), gi losses, and renal K wasting (hyperaldosteronism, diuretics)
44
seborrheic keratosis
benign epidermal tumor that presents in middle-aged or elderly indivs as a tan or brown, round lesion with a well-demarcated border and "stuck-on" appearance
-diagnosis is based primarily on clinical appearance, and tx is usually not required
45
RCC
```
flank pain, hematuria, and palpable abdo renal mass
scrotal varicoceles (l-sided_
paraneoplastic symptoms:
-anemia or erythrocytosis
-thrombocytosis
-fever
-hypercalcemia
-cachexia
```
46
classeification of angina
1. classic
- typical location (substernal), quality and duration
- provoked by exercise or emotional stress
- relieved by rest or nitroglycerin
2. atypical:
- 2 of the 3 of classical
3. non-anginal:
- <2 of 3 of classical
47
Dobutamine
- potent inotropic agent with a strong affinity for beta-1 receptors and a weak affinity for beta-2 and alpha-1 receptors
- stimulates inc myocardial contractility leading to improved EF, reduced LVESV and symptomatic improvement of decompensated HF
48
increased incidence or orthostatic hypoTN in the elderly
progressively decreasing baroreceptor sensitivity and defects in the myocardial response to this reflex are the main reasons
49
70% of cases of interstitial nephritis are caused by drugs such as
```
cephalosporins
penicillins
sulfonamides
sulfonamide containing diuretics
NSAIDs
Rifampin
phenytoin
allopurinol
```
50
patellofemoral pain syndrome
- common cause of anterior knee pain in young women
- usually d/t chronic overuse of malalignment
- patellofemoral compression test can reproduce the pain
- initial management: activity modification, NSAIDs, and strengthening and stretching exercises
51
acute pericarditis etiology
- viral or idiopathic
- ai (SLE)
- uremia (acute or chronic renal failure)
- postmyocardial infarction
- -early: peri-infarction pericarditis
- -late: Dressler syndrome
52
clinical features and diagnosis of acute pericarditis
- pleuritic CP (dec when sitting up) +/- fever
- pericardial friction rub (highly specific)
- ecg: diffuse ST elevation and PR depression
- echo: pericardial effusion
tx: NSAIDs and colchicine for viral or idiopathic; variable for other etiologies
53
H pylori and MALT
- H pylori infection plays critical role in pathogenesis of extranodal marginal zone B cell lymphomas (low grade B cell lymphoma of mucosa-associated lymphoid tissue (MALT) of the stomach
- all pts with MALT lymphomas should be tested for H pylori infection and those with a positive result and early stage MALT lymphoma should undergo H pylori eradication therapy (quadruple therapy)
54
a fib and pulmonary veins
- a fib is most commonly caused by ectopic foci within the pulmonary veins
- atrial flutter commonly involves a reentrant circuit around the tricuspid annulus
- AV nodal reentry tachycardia results from a reentrant circuit formed by 2 separate conducting pathways within the AV node
55
sn and sp
sn=tp/(tp+fn)
sp=tn/(tn+fp)
56
secondary bacterial PNA
- m/c influenza complication and should be suspected when gever and pulmonary s/s worsen after initial improvement
- most cases occur in pts age >65 but CA-MRSA has a predilection for young pts with recent influenxa
- -this pathogen causes rapidly progressive, necrotizing PNA with high fever, productive cough (often with hemoptysis), leukopenia, and multilobar cavitary infiltrates
57
important RF for DVT and PT
obesity and malignancy
- wheezing can occur in acute PE
- elevated alveolar-arterial oxygen gradient is commonly seen in pts with PE
58
CP of acute diverticulitis
- abdominal pain (usually LLQ)
- f/n/v
- ileus (peritoneal irritation)
59
diagnosis, management, complications of acute diverticulitis
diagnosis: abdominal CT (oral and iv contrast)
management: bowel rest, Abx (cipro, metro)
complications: abscess, obstruction, fistula, perforation
60
laxative abuse
- characterized by frequent, watery, nocturnal diarrhea
- diagnosis suggested by a positive laxative screen or colonoscopy with characteristic findings of melanosis coli (dark brown discoloration with pale patches of lymph follicles)
61
diverticulosis is associated with chronic constipation
- its usually asymptomatic, but potential complications include hemorrhage and diverticulitis
- r/o complications is lower with a high intake of fruit and veggie fiber, and higher with heavy meat consumption, ASA, or NSAIDs, obesity, and possibly smoking
62
spontaneous subconjunctival hemorrhage
benign finding that doesnt require any tx
