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~MEDICINE~ > UWorld 2 > Flashcards

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
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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

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3
Q

disseminated gonococcal infection

A

-triad: polyarthralgias, tenosynovitis, vesiculopustular skin lesions

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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
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5
Q

retinal detachment

A

cp: sudden onset of photopsia and floaters; “a curtain coming down over my eyes”

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6
Q

MEN1

A

-primary hyperparathyroidism (hypercalcemia), pituitary tumors (prolactin, visual defects), pancreatic tumors (especially gastrinomas)

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7
Q

MEN 2A

A

-MTC (calcitonin), pheochromocytoma, parathyroid hyperplasia

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8
Q

MEN 2B

A

-MTC (Calcitonin), pheochromocytoma, mucosal neuromas/marfinoid habitus

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9
Q

age related macular degeneration

A
  • in pts >50yo

- cp: progressive and b/l l/o ctl vision; navigational vision is preserved

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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
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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
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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
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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

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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)
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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

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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
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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
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18
Q

dietary recs for pts with renal calculi

A
  • inc fluid intake
  • dec sodium intake
  • nml dietary calcium intake
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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
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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
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21
Q

management for acute opioid intoxication

A
  • NALOXONE (may need repeated dosings)
  • AW management and ventilation
  • exclude other AMS causes (hypoglycemia)
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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

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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
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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

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25
Q

ascites

A
  • 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
Q

membranous nephropathy

A

-m/c form of nephrotic syndrome associated with carcinoma

27
Q

small cell carcinoma of the lung

A

usually causes other paraneoplastic syndromes such as ACTH production and SIADH

28
Q

etiology of prerenal acute kidney injury

A

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
Q

clinical features of prerenal acute kidney injury

A
  • 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
Q

disseminated gonococcal infection

A

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
Q

acute gout

A

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
Q

m.c c/o urinary retention in elderly males

A

-enlarged prostate which is usually revealed by rectal exa, and characterized by high postvoid residual volume

33
Q

inflammatory bowel dz

A
  • 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
Q

clinical presentation of asbestosis ( an pneumoconiosis form particle inhalation)

A
  • 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
Q

diagnostic eval of asbestosis

A
  • pleural plaques on chest imaging

- imaging, PFT (shows restrictive lung dz) and histology consistent with pulmonary fibrosis

36
Q

presbyopia

A

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
Q

toxic megacolon

A
  • 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
Q

nasal polyps

A
  • 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
Q

presbycusis

A
  • 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
Q

hypertensive urgency vs emergency

A

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
Q

COPD pts

A

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
Q

Trastuzumab

A
  • 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
Q

hypokalemia

A

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
Q

seborrheic keratosis

A

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
Q

RCC

A 
flank pain, hematuria, and palpable abdo renal mass
scrotal varicoceles (l-sided_
paraneoplastic symptoms:
-anemia or erythrocytosis
-thrombocytosis
-fever
-hypercalcemia
-cachexia
46
Q

classeification of angina

A
  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
Q

Dobutamine

A
  • 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
Q

increased incidence or orthostatic hypoTN in the elderly

A

progressively decreasing baroreceptor sensitivity and defects in the myocardial response to this reflex are the main reasons

49
Q

70% of cases of interstitial nephritis are caused by drugs such as

A 
cephalosporins
penicillins
sulfonamides
sulfonamide containing diuretics
NSAIDs
Rifampin
phenytoin
allopurinol
50
Q

patellofemoral pain syndrome

A
  • 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
Q

acute pericarditis etiology

A
  • viral or idiopathic
  • ai (SLE)
  • uremia (acute or chronic renal failure)
  • postmyocardial infarction
  • -early: peri-infarction pericarditis
  • -late: Dressler syndrome
52
Q

clinical features and diagnosis of acute pericarditis

A
  • 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
Q

H pylori and MALT

A
  • 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
Q

a fib and pulmonary veins

A
  • 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
Q

sn and sp

A

sn=tp/(tp+fn)

sp=tn/(tn+fp)

56
Q

secondary bacterial PNA

A
  • 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
Q

important RF for DVT and PT

A

obesity and malignancy

  • wheezing can occur in acute PE
  • elevated alveolar-arterial oxygen gradient is commonly seen in pts with PE
58
Q

CP of acute diverticulitis

A
  • abdominal pain (usually LLQ)
  • f/n/v
  • ileus (peritoneal irritation)
59
Q

diagnosis, management, complications of acute diverticulitis

A

diagnosis: abdominal CT (oral and iv contrast)
management: bowel rest, Abx (cipro, metro)
complications: abscess, obstruction, fistula, perforation

60
Q

laxative abuse

A
  • 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
Q

diverticulosis is associated with chronic constipation

A
  • 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
Q

spontaneous subconjunctival hemorrhage

A

benign finding that doesnt require any tx

~MEDICINE~ (5 decks)

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