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~MEDICINE~ > UWorld 3 > Flashcards

UWorld 3 Flashcards

1
Q

left ventricular aneurysm

A

etiology: scar tissue deposition following transmural MI
CP:
-several months following MI
-HF and angina
-ventricular arrhythmia (ventricular tachycardia)
-systemic embolization (eg stroke)

diagnosis:

  • ecg: persistent ST elevation, deep Q waves
  • echo: thin and dyskinetic myocardial wall
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2
Q

general manifestations of HYPERthyroidism

A

symptoms: anxiety and insomnia, palpitations, heat intolerance, inc perspiration, weight loss sans dec appetite

PE: goiter, HTN, tremors involving fingers/hands, hyperreflexia, proximal muscle weakness, lid lag, afib

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3
Q

hypothyroidism

A
  • can cause additional metabolic abnormalities such as: hyperlipidemia, hyponatremia, and asymptomatic elevations of creatinine kinase and serum transaminases (AST, ALT)
  • most pts have hypercholesterolemia alone (d/t dec LDL surface receptors and/or dec LDL receptor activity) or combined hyperTG (d/t dec lipoprotein lipase activity)
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4
Q

chagas dz

A

chronic dz that can cause megaesophagus, megacolon, and/or cardiac dysfunction
-protozoan Trypanosoma cruzi, endemic to Latin America is responsible

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5
Q

renal vein thrombosis

A
  • important complication of all causes of nephrotic syndrome

- most commonly associated with membranous glomerulopathy

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6
Q

miliary TB

A
  • typically presents with subacute or chronic fevers, weight loss, fatigue, and pulmonary symptoms
  • CXR classically reveals a diffuse reticulonodular patter (millet seed)
  • m.c behavioral RF for TB in the US is substance abuse
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7
Q

what can precipitate priapism

A
  • meds: trazadone, prazosin

- medical conditions: SCD, perineal trauma

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8
Q

tumor lysis syndrome

A

risk: initiation of cytotoxic chemo
manifestations: severe electrolyte abnormalities (inc phosphorus, potassium, uric acid; dec calcium); acute kidney injury (d/t uric acid/calcium phosphorus); cardiac arrhythmias
tx: continue telemetry, aggressive electrolyte monitoring/tx
ppx: IV fluids, allopurinol or rasburicase

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9
Q

NSAIDs and anemia

A
  • NSAIDs are a common cause of iron deficiency anemia often through chronic blood loss from the GI tract
  • elderly pts often have a low-grade chronic anemia at baseline and may not tolerate additional blood loss
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10
Q

initial tx regimen in pts with intermitten cluadication

A
  • should include a supervised exercise program
  • pharm therapy with cilostazol and percutaneous or surgical revascularization should be reserved for those with persistent symptoms despite adequate supervised exercise therapy
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11
Q

isolated systolic HTN

A
  • important cause of HTn in elderly pts
  • caused by inc stiffness or dec elasticity of the arterial wall
  • assoc with an inc in CV m&m and management should be similar to that of primary HTN with lifestyle modifications and pharm therapy
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12
Q

chronic mesenteric ischemia

A

etiology: atherosclerosis (smoking, dyslipidemia)

clinical features: crampy, postprandial, epigastric pain; food aversion and weight loss

diagnosis: signs of malnutrition, abdominal bruit, CT angiography (preferrd), Doppler US
management: risk reduction (tobacco reduction), nutritional support; endovascular or open surgical revascularization

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13
Q

negative predictive value

A
  • probability of being free of a disease if the test result is negative
  • NPV will vary with the pretest probability of a dz
  • -a pt with a high probability of having a dz will have a low NPV
  • -a pt with a low probability of having a dz will have a high NPV
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14
Q

what is the mainstay of symptom management in COPD

A
  • inhaled anti-muscarinic bronchodilators agents such as Ipratropium
  • these anti-cholinergic meds may be combined with short-actin beta-adrenergic agonists for greater symptom relief
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15
Q

etiology of acute limb ischemia

A
  • cardiac/arterial embolus (AF, LV thrombus, IE)
  • arterial thrombosis (PVD)
  • iatrogenic/blunt trauma
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16
Q

clinical features and management of acute limb ischemia

A

6Ps of acute limb ischemia

  • pain
  • pallor
  • paresthesias
  • pulselessness
  • poikilothermia (cool extremity)
  • paralysis (late)

management: anticoagulation (heparin) and thrombolysis versus surgery

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17
Q

common causes of myopathy

A

connective tissue diseases

  • polymyositis/dermatomyositis
  • inclusion body myositis
  • overlap syndrome (mixed CTD)

endocrine/metabolic

  • hypothyroidism, thyrotoxicosis
  • Cushing syndrome
  • electrolytes (dec K, Ca, Phosphorus)

drugs/toxins

  • corticosteroids, statins
  • zidovudine, colchicine
  • EtOH, cocaine, heroin

miscell.
-infections, trauma, hyperthermia

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18
Q

long term cyclophosphamide use

A

associated with inc incidence of acute hemorrhagic cystitis and bladder carcinoma

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19
Q

S4**

A

low frequency sound heard at the end of diastole just before S1 that is commonly associated with LVH from prolonged HTN

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20
Q

what is the most dangerous complication of Marfan syndrome

A

AORTIC DISSECTION

  • typically presents as tearing CP radiating to the back and neck
  • must be identified immediately to dec r/o death
  • aortic regurg is a complication of aortic dissection and presents with an early diastolic murmur
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21
Q

massive pulmonary embolism

A

likely in a postop pt with: hypoTN, jugular vein distention, and new-onset RBBB

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22
Q

clinical manifestations of hereditary hemochromatosis

A
  • skin: hyperpigmentation (bronze diabetes)
  • MSK: arthralgias, arthropathy, chondrocalcinosis
  • GI: elevated hepatic enzymes with hepatomegaly (early), cirrhosis (later), and inc r/o HCC
  • endo: DM, secondary hypogonadism, hypothyroidism
  • cardiac: restrictive or dilated cardiomyopathy and conduction abnormalities
  • infections: inc susceptibility to Listeria, vibrio vulnificus, and yersinia enterocolitica
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23
Q

mitral valve prolapse

A

m/c c/o mitral regurg in developed countries

  • usually causes mild MR with mid-systolic click and mid-to-late systolic murmur
  • pts with severe leaflet dysfunction an dprolapse can develop severe MR and holosystolic murmur on PE
  • chronic severe MR causes LA and ventricular enlargement leading to afib, LV dysfunction, and CHF
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24
Q

secondary malignancy in pts with Hodgkin lymphoma

A
  • is common when pt is treated with chemo and radiation
  • m/c secondary solid tumor malignancies are lung (especially in smokers), breast, thyroid, bone, and GI (colorectal, esophageal, gastric tumors)
25
Q

major RF for pancreatic cancer

A

hereditary:

  • first degree relative with pancreatic ca
  • hereditary pancreatitis
  • germline mutations (BRCA1, BRCA2, Peutz-Jeghers syndrome)

environmental

  • cigarette smoking (most significant)
  • obesity, low physical activity
  • nonhereditary chronic pancreatitis
26
Q

what are some RF for premature atrial contractions

A
  • tobacco and alcohol are reversible ones

- beta blockers often help symptomatic pts

27
Q

pathophysiology of GERD

A
  • dec tone or excessive transient relaxations of LES
  • anatomic disruption to gastroesophageal jxn (hiatal hernia)
  • inc risk with obesity, pregnancy, smokine, EtOH intake
28
Q

manifestations of GERD

A
  • regurg of acidic material in mouth
  • heartburn
  • odynophagia (often indicates reflux esophagitis)
  • extraesophageal: cough, hoarseness, wheezing
29
Q

complications and tx of GERD

A

complications:

  • esophageal-erosive esophagitis, Barrett esophagus, strictures
  • extraesophageal-asthma, laryngitis

tx: lifestyle (weight loss) and dietary changes, H2R blocker or PPI

co-morbid GERD is common in pts with asthma and can worsen asthma s/s 2/2 microaspiration

30
Q

TPN

A

causes gallbladder stasis and predisposes to gallstone formation and bile sludging–>can both lead to cholecystitis

31
Q

RA tx

A

-start with MTX (DMARD)
-if persistent s/s >6mo either do:
—step-up therapy: add biologic agent (TNF inhibitor)
or
—parallel therapy (add another nonbiologic agent: sulfasalazine, hydroxychloroquine)

if step-up therapy is an inadequate response switch to alternate TNF inhibitor and continue MTX

32
Q

angiodysplasia

A
  • characterized by dilated submucosal veins and AV malformations
  • common c/o recurrent, painless GI bleeding
  • diagnosis made on colonoscopy
  • asymptomatic pts dont need tx
  • with anemia or bleeding can be treated with cautery
33
Q

malignant otitis externa

A
  • serious infection of ear seen in elderly pts with poorly controlled diabetes
  • m/c 2/2 Pseudomonas
  • CP: ear pain and ear drainage, granulation tissue may be seen within the ear canal on exam
  • progression of infection can lead to osteomyelitis of the skull base and destruction of the facial nerve
34
Q

acute mitral regurg

A
  • can occur d/t papillary muscle displacement in pts with acute MI
  • leads to abrupt and excessive volume overload causing elevated LA and ventricular filling pressures and acute pulm edema
  • unlike chronic MR, acute MR doesnt cause any significant change in LA or ventricular size and/or compliance
35
Q

AF with rapid ventricular response

A
  • rate control should be attempted initially with beta blockers or CCB
  • immediate synchronized electrical cardioversion is indicated in hemodynamically unstable pts with rapid AF
36
Q

ARP

A

=(risk in exposed-risk in unexposed)/risk in exposed

=(RR-1)/RR

37
Q

vasospastic angina

A

path: hyperactivity of coronary smooth muscle

CP: young pts (<50), smoking (minimal other CAD RF), recurrent chest discomfort (occurs at rest or d/r sleep, spontaneous resolution =15mins)

diagnosis: ambulatory ecg: ST elevation, coronary angiography: no CAD
tx: CCB (preventive), sublingual nitroglycerin (abortive)

38
Q

intravascular hemolytic anemia

A
  • elevated retic count: d/t inc BM production in setting of anemia
  • inc LDH: f/m LDH release from broken down erythrocytes
  • dec haptoglobin: the released Hgb binds to haptoglobin, and the haptoglobin-Hgb complex is hepatically cleared, leading to low or undetectable plasma haptoglobin levels
39
Q

macrovascular traumatic hemolysis

A
  • when hemolysis is caused by mechanical trauma from calcified aortic valves
  • usually seen with artificial heart valves or markedly calcified valves
  • periph blood smear of pts typically reveals helmet cells or fragmented erythrocytes
40
Q

COPD

A

characterized by progressive expiratory airflow limitation which causes air trapping, dec VC and inc TLC
-FEV1 is disproportionately dec as compared to VC

41
Q

infective endocarditis in IVDU

A
  • HIV infection inc IE risk in IVDU
  • S. aureus is the m/c organism
  • tricuspid involvement (r-sided) m/c than aortic valve
  • -often lacks audible heart murmur
  • -septic PE common
  • -fewer peripheral IE manifestations (splinter hemorrhages, Janeway lesions)
  • -HF more common in aortic valve involvement, but rare with tricuspid valve dz
42
Q

giant cell tumor of bone

A
  • benign and locally aggressive skeletal neoplasm that usually presents with pain, swelling, and dec range of jt motion at involved ite
  • typically presents as osteolytic lesions (with a “soap-buttle” appearance on radiographs) in the EPIPHYSEAL regions of the long bones and m/c involves the distal femur and proximal tibia a/r the knee jt
43
Q

glomerular hyperfiltration

A
  • earliest renal abnormality seen in diabetic nephropathy
  • major pathophysiologic mechanism of glomerular injury in these pts
  • thickening of the glomerular basement membrane is the first change that can be quantitated
44
Q

alveolar hypoventilation with CO2 retention

A

can lead to respiratory acidosis along with CO2 narcosis
-acute kidney injury can cause a non anion gap metabolic acidosis d/t impaired acid excretion or an anion gap acidosis d/t retention of unmeasured uremic toxins

45
Q

RF/association sof aortic dissection

A
  • HTN (m/c)
  • Marfan syndrome
  • cocaine use
46
Q

clinical features of aortic dissection

A
  • severe, sharp, tearing chest or back pain

- >20mmHg variation in systolic BP b/w arms

47
Q

complications (involved structure) of aortic dissection

A
  • stroke (carotid arteries)
  • acute aortic regurg (aortic valves)
  • Horner syndrome (superior cervival sympathetic ganglion)
  • acute myocardial ischemia/infarction (coronary artery)
  • pericardial eddusion/cardiac tamponade (pericardial cavity)
  • hemothorax (pleural cavity)
  • LE weakness or ischemia (spinal or common iliac arteries)
  • abdo pain (mesenteric artery)
48
Q

pts with severe BOO d/t BPH

A
  • can develop AKI

- renal US is advised for assessment of hydronephrosis in those with worsening kidney function

49
Q

solid organ transplant

A
  • at risk for opportunistic infections (most notable Pneumocystitis PNA and CMV)
  • in absence of ppx, pts who present with a systemic illness involving multiple organ systems (eg pneumonitis, hepatitis, gastroenteritis) should be tested for CMV viremia
50
Q

hypovolemia

A
  • common cause of orthostatic hypotension and orthostatic syncope especially in elderly pts
  • d/t dec renal perfusion and activation of the RAAS dec urine sodium is usually present in pts with hypovolemia
51
Q

syncope

A
  • pts with an arrhythmic c/o syncope usually have underlying structural heart disease and may not have any prodromal s/s prior to the syncopal episode
  • in contrast, those with vasovagal or neurocardiogenic syncope frequently experience a prodrome with nausea, pallor, diaphoresis, and generalized sense of warmth prior to the syncopal episode
52
Q

UC

A
  • s/s: bloody diarrhea, weight loss, fever
  • endoscopic findings: erythema, friable mucosa, pseudopolyps, involvement of rectosigmoid, continuous colonic involvement (no skip lesions)
    bx: muscosal and submucosal inflamm, crypt abscesses
    complications: toxic megacolon, PSC, CRC, erythema nodosum, pyoderma gangrenosum, spondyloarthritis
53
Q

tinea corporis (ringworm)

A

RF:

  • athletes who have skin-to-skin contact
  • humid environment
  • contact with infected animals (rodents)

presentation:

  • scaly, erythematous, pruritic patch with centrifuged spread
  • subsequent central clearing with raised annular border

tx:

  • first-line/localized: topical antifungals (Clotrimazole, Terbinafine)
  • second-line/extensive: oral antifungals (Terbinafine, Griseofulvin)
54
Q

bacterial meningitis should be suspected in pts with >/=2 of the following manifestations:

A
  • HA
  • fever (usually >38 C [100.4F])
  • nuchal rigidity
  • AMS
55
Q

EPO

A
  • tx of choice for anemia related to CKD
  • HTN is a common SE of EPO
  • pts who receive large doses or experience a rapid rise in Hgb concentration are at highest risk
56
Q

m/c c/o mitral stenosis

A
  • m/c d/t rheumatic heart dz and presents with gradual and progressively worsening dyspnea or orthopnea
  • afib is a common complication and can cause rapid decompensation in previously asymptomatic pts
  • longstanding mitral stenosis can cause severe LAE leading to an elevation of the left main bronchus on chest radiograph
57
Q

euthyroid conditions that alter TBG concentration

A
  • INC TBG (inc total T4; nml free T4)
  • -estrogens (pregnancy, OCPs, HRT)
  • -hepatic dysfunction (acute hepatitis)
  • -medications (Tamoxifen)
  • dec TBG (dec total T4, nml free T4)
  • -hormonal abnormalities (Cushing, GC)
  • -hypoproteinemia (nephrotic syndrome, starvation)
  • -medications (niacin, high-dose androgens)
58
Q

arsenic poisoning

A

mech: binds to sulfhydryl groups and disrupts cellular respiration and gluconeogenesis
sources: pesticides/insecticides; contaminated water (often from wells), pressure-treated wood

manifestations:

  • acute: garlic breath, vomiting, watery diarrhea, QTc prolongation
  • chronic: hypo/hyperpigmentation, hyperkeratosis, stocking-glove neuropathy

tx: dimercaprol (british anti-Lewisite); DMSA

~MEDICINE~ (5 decks)

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