UWorld 4 Flashcards
1
Q
PCOS @ risk for what cancer
A
endometrial
2
Q
which kid UTIs get an U/S
A
- < 24 mo
- recurrent UTIs in kids
- UTI with fam hx renal dz
- UTI doesn’t respond to abx
3
Q
tx: tourettes
A
antipsychotics
alpha-2 adrenergics
4
Q
urinalysis with envelope shaped crystals
A
ethylene glycol poisoning
5
Q
when do you suspect septic pelvic thrombophlebitis
A
post c-section of pelvic surgery
look for refractory fever after abx given for endometritis/chorioamnionitis
6
Q
tx: septic pelvic thrombophlebitis
A
anticoagulation
broad spectrum antibiotics
7
Q
MC cardiac defect in Downs
A
complete AV septal defect
8
Q
auscultation in complete AV septal defect
A
loud S2 (pulm HTN) systolic ejection murmur (ASD) holosystolic murmur (VSD)
9
Q
when do you get wernicke’s encephalopathy
A
alcoholism
hyperemesis gravidarum
(both get thiamine)
10
Q
what UA things will you see with prerenal AKI
A
BUN/Cr > 20
FeNa < 1%
no sig casts or protein or cells
11
Q
CI: what’s significant with RR
A
doesn’t include 1
12
Q
when do kids get visual acuity exams
A
start at 3
every well child visit
13
Q
CXR: nodular lesions with surrounding ground-glass opacities
A
think about invasive pulmonary aspergillosis
14
Q
WPW EKG
A
short PR
delta wave
wide QRS with ST/T wave changes
15
Q
underlying WPW problem
A
accessory pathway bypasses AV node
16
Q
MCC clubbing
A
lung malignancies
CF
right to left shunts (cyanotic ones)
17
Q
risk a/w scaphoid frx
A
osteonecrosis
18
Q
tx: BPH
A
alpha antags (-zosins) 5-alpha reductase inhibitors (finasteride) -- takes 6 - 12 mo
19
Q
which APGARs get resuscitation
A
< 7
20
Q
at what HR do you give a neonate chest compressions
A
< 60
21
Q
tx: acute bipolar depression
A
*quetiapine/lurasidone
*lamotrigine
lithium
valproate
olanzapine and fluoxetine
22
Q
what to think about with right heart failure
A
pulm HTN constrictive pericarditis (low venous return)
23
Q
hyposthenuria
A
can’t concentrate urine
a/w sickle cell
24
Q
dream enactment dx
A
REM sleep behavior d/o
may be prodromal for neurodegeneration
25
tx: ITP (kids)
if only cutaneous sx observe (most better in 6 mo)
| if they're bleeding give IVIg or glucocorticoids
26
that normal rash on newborns
erythema toxicum neonatorum
27
crazy dry, scaly skin, worse in winter
ichthyosis vulgaris
28
tx: ichthyosis vulgaris
emollients first
| then try keratolytics (salicylic) or retinoids
29
tx: neonatal conjunctivitis
GC: IM ceftriaxone
chlamydia: PO macrolide
30
whats the name of the other bovis
gallolyticus
31
risks of EPO therapy in ESRD pts
worsening HTN
HA
red cell aplasia (rare)
32
urinary problems post menopause
GU syndrome of menopause
| E deficiency --> atrophy of vagina and urethral epithelium --> UTIs, incontinence (stress and urge)
33
high loss to follow up --> what kind of bias
attrition (selection bias)
34
tx: pseudotumor cerebri
1. acetazolamide
| 2. shunt if doesn't work (LPs or steroids till surgery)
35
head/neck firm, solitary, non-tender LN in smoker
probably SCC
36
HTN effects on kidney
atherosclerotic lesions
| nephrosclerosis (hypertrophy and fibrosis of arterioles) --> glomerulosclerosis
37
MC lung cancer in nonsmokers
adenocarcinoma
38
swelling w/o discoloration on newborn head over 1 cranial bone
cephalohematoma
39
diffuse swelling +/- discoloration on newborn head
caput succedaneum
40
eye: stony hard
think acute angle glaucoma
41
path: inflammatory spondyloarthritis
inflammation at ligamentous insertions (enthesitis)
42
age: UC
bimodal -- young or old (15 - 40; 50 - 80)
43
why do women get hTN post epidural (+ppx)
block sympathetic nerves --> vasodilation (give IVF before)
44
ddx: terminal hematuria
bleeding from bladder, prostate or post urethra
| clots --> think CA
45
fetal malposition vs malpresentation
malposition: relation of presenting part to pelvis
malpresentation: presenting part
46
optimal fetal position
occiput anterior
47
optimal fetal presentation
vertex
48
MCC of arrested 2nd stage
fetal malposition
49
what to check in kid with recurrent cystitis
constipation (--> stasis)
50
ppx: post cat bite
amoxicillin/clavulanate
51
cushing's dx: 1st step in workup
24 hr cortisol, late night salivary cortisol and/or low dose dexamethasone
52
ddx: conductive hearing loss
cerumen impaction
middle ear infection
bony tumors/ear bones not moving
otosclerosis
53
MC org: contact lens keratitis
pseudomonas
| gram negs
54
when does OR = RR
when disease incidence is low
55
mgmt: SCC of head/neck
1. panendoscopy
| 2. bx
56
when to suspect amyloidosis nephrotic syndrome
RA
| enlarged kidneys/liver
57
systolic-diastolic abdominal bruit
renal artery stenosis
58
pelvic U/S: ovarian mass w/ thickened endometrium
granulosa cell tumor
59
malignant HTN
retinal hemorrhages
| papilledema
60
AEs: trastuzumab
cardiotoxicity (get an echo before you start)
61
possible nerve stuff with preeclampsia with severe features
hyperreflexia
62
porcelain GB @ risk for
GB adenocarcinoma
63
female: high T and androstenedione, no estradiol or estrone
aromatase deficiency
64
kid: daily fever, arthritis, and pink macular rash
juvenile idiopathic arthritis
65
causes of chronic renal insufficiency in kids
think vesicoureteral reflux or posterior urethral valves (boys only)
66
BUN/Cr > 20
prerenal azotemia
67
morbid obesity effect on girl hormones
--> anovulation
ovaries still make E --> normal FSH/LH
they just don't make progesterone
68
carcinoid vit deficiency
niacin
69
eyes: distortion of straight lines
macular degeneration
70
pale, edematous nasal mucosa
allergic rhinitis
71
ovarian tumor making E
granulosa cell tumors
72
ovarian tumor making beta hCG
dysgerminoma
73
ovarian tumor making androgens
sertoli-leydig
74
ovarian tumor making LDH
dysgerminoma
75
tx: hypovolemic hypernatremia
NS
76
RFs hypertriglyceridemia
```
fam hx
DM/obesity
hypothyroidism
nephrotic syndrome
EtOH
```
77
dx: bronchiectasis
chest CT: bronchial dilation/thickening with lack of airway tapering
78
kid bone x ray: hypodense lesion w/ sclerotic margins
think of osteoid osteoma
79
RFs shoulder dystocia
macrosomia
maternal obesity/excess weight gained in pregnancy
GDM
post-term
80
sarcoidosis: non-lung things
eyes: uveitis
skin: erythema nodosum
cardio: can cause AV block and LBBB, dilated or restrictive CM
81
pain from endometriosis vs pain from dysmenorrhea
endometriosis usually hurts a couple days before menses, not first couple days of menses
82
Hep C preggo
give hep A/B vaccines if hasn't had them
don't treat (teratogens)
breastfeeding is fine
c-section won't help
83
RFs for vertical hep C transmission
HIV co-infection
| high viral load
84
how do you know if they're doing EPO or steroids
EPO doesn't have aggression, testicular atrophy or gynecomastia
85
ITP vs TTP CBC
ITP: thrombocytopenia
TTP: hemolytic anemia + thrombocytopenia
86
pancytopenia after meds, toxins or viral infxn
aplastic anemia
87
meth vs PCP
no nystagmus in meth
| meth lasts longer (20+ hrs), PCP lasts < 8 hrs
88
best way to transport an amputated finger
wrap in gauze, moisten with saline, put in bag, put bag on ice
89
otitis media complications
facial nerve palsy
| mastoiditis
90
mumps complications
aseptic meningitis
| orchitis (+ infertility)
91
measles complications
pneumonia
| subacute sclerosing panencephalitis
92
post surgery: tachycardia, HTN, arrhythmias, tremor, AMS, lid lag
thyroid storm
93
oxytocin toxicity
similar to ADH --> hNa, hTN, tachysystole
| hNa --> HA, n/v, seizures
94
bleeding problems in CF pts
panc insufficiency --> vit K def --> factor 1972, C, S --> PT up
95
who gets PPSV23 before 65
chronic heart, lung, or liver dz (kidney gets both)
| DM, smokers, alcoholics
96
mgmt: hypovolemic hypernatremia
NS till euvolemic
then can switch to hypotonic (5% dextrose or 1/2NS)
don't do water deprivation test till euvolemic
97
how do nitrates help
systemic venodilation --> down preload, LVEDV
98
calcium oxalate crystals in urine
ethylene glycol poisoning
99
tx: cyanide poisoning
sodium thiosulfate
100
when do you give fomepizole
ethylene glycol
| methanol
101
tx: elevated homocysteine levels
B6 + folate
| give B12 if low
102
what drugs cause acne
glucocorticoids
cyclosporine/azathioprine
antiTB, anticonvulsants
103
mgmt: chondrocalcinosis
pseudogout
| check for HPTH, hTh and hemochromatosis
104
which afibbers get anticoagulated
```
CHADS VASC
CHF
HTN
Age > 75 (2)
DM
Stroke (2)
Vascular dz
Age 65 - 74
Sex category
0 = none, 1 = ASA, 2+ = oral anticoags
```
105
path: COPDer gets a pneumo
alveolar destruction --> blebs --> blebs rupture --> air leaks into pleural space --> pneumo
106
mutation in Lesch-Nyhan
Hypoxanthine-guanine phosphoribosyl transferase (HPRT)
107
abx for rheumatic fever
initial dx: PCN
PPx: q 4 wks
RF w/o carditis: for 5 years or till 21 (longer one)
RF w/ carditis: 10 or 21
RF w/ carditis and persistent valvular dz: 10 or 40
108
path: Crohn's pt w/ kidney stones
fat malabsorption --> fat binds to Ca in gut --> Ca doesn't bind to oxalate in gut --> up absorption of oxalate absorption --> Ca oxalate stones
109
drugs that increase risk of heat stroke
anticholinergics
antihistamines
phenothiazines
TCAs
110
complication of whiplash
syringomyelia
111
syringomyelia sxs
decreased motor, pain/temp
| light touch, vibe intact
112
biggest RF for ischemic vs hemorrhagic stroke
both are HTN
113
kid: fever, pharyngitis, vesicles/grey ulcers in posterior pharynx
herpangina (coxsackie A)
114
conjugated hyperbili + normal AST/ALT/AlkPhos
Dubin-Johnson
| Rotor
115
conjugated hyperbili + elevated AST/ALT + normal AlkPhos
intrinsic liver dz
| viral hepatitis, hemochromatosis
116
conjugated hyperbili + slightly elevated AST/ALT + crazy high AlkPhos
```
intrahepatic cholestasis (PBC)
biliary obstruction
```
117
pitting vs nonpitting edema
lymphedema = nonpitting
| liver/heart/kidney fail = pitting
118
suprasellar, calcified mass
craniopharyngioma
119
nephrotic syndrome + restrictive CM + big organs + waxy skin + bleeding
amyloidosis
120
amyloidosis a/w
```
RA
chronic infections (TB, bronchiectasis)
IBDs
malignancy
vasculitis
```
121
dx: amyloidosis
bx fat pad
122
GVHD: areas of attack
skin (maculopapular rash)
guts (bloody diarrhea)
liver (LFTs, jaundice)
123
path: GVHD
donor T cells
124
thrombotic vs embolic strokes
thrombotic has stuttering progression w/ periods of improvement
embolic is abrupt and worse at the beginning. diff infarcts in diff places
125
tx: stable angina
ASA
NG
BB +/- CCB
126
tx: CMV
ganciclovir
127
wheres the lesion: hemineglect
parietal on opposite side of neglect
| neglect right = left parietal
128
bernard sequard syndrome
ipsilateral hemiparesis
ipsi prop/vibe/light touch
contra pain/temp (start two down from lesion)
129
tx: spontaneous pneumo
small, stable: obs and O2
large, stable: needle decompression
large, unstable: tube thoracostomy
130
chronic bronchitis vs bronchiectasis
chronic usually from smoking, bronchiectasis from recurrent infxns
131
carcinoid heart/lungs
```
valvular lesions (R > L)
bronchospasm
```
132
tenosynovitis, dermatitis (pustules), asymmetric migratory polyarthralgias
disseminated GC
133
oligoclonal bands in CSF
MS
134
multiple peptic ulcers and diarrhea
Zollinger Ellison
135
explain steatorrhea in ZES
excess gastric acid inactivates panc enzymes
136
mgmt: crazy lung bleed
bad lung down (lateral recumbent)
| bronchoscopy
137
what is the "dominant" lobe
R handed = L lobe dominant
138
lobe for brocas aphasia
dominant frontal
139
lobe for wernickes aphasia
dominant temporal
140
amphetamines in pregnancy risks
FGR, fetal demise
preterm labor
placental abruption
preeclampsia
141
GDM sugar goals
fasting < 95
1 hr postprandial < 140
2 hr postprandial < 120
142
mgmt: shoulder dystocia
BE CALM
1. Breathe, don't push
2. Elevate hips against abdomen (McRoberts)
3. Call for help
4. Apply suprpubic pressure
5. enLarge vaginal opening (episiotomy)
6. Maneuvers
143
shoulder dystocia maneuvers
deliver posterior arm
rotate 180 (Wood's corkscrew)
collapse ant shoulder (Rubin)
replace fetal head for c-section (Zavanelli)
144
RAS system in pancreatitis
hypovolemia --> renin --> up renal vessel SVR and up Na reabsorption
145
MC orgs epididymitis
< 35: neisseria gonorrhea
| > 35: e coli
146
MC orgs: osteomyelitis in kids
healthy: staph
sickle: salmonella or staph
147
melanosis coli
dark brown colon discoloration
| laxative abuse
148
tx: patellofemoral pain syndrome
quad/hip abd/knee extensors exercises
| no high impact
149
complement and platelets in HSP
normal
150
secondary HTN with evidence of atherosclerosis
think renovascular dz
151
secondary HTN with brachial-femoral pulse delay
coarctation
152
secondary HTN with hypokalemia
hyperaldo
153
secondary HTN with constipation, fatigue
hypothyroid
154
secondary HTN with proximal muscle weakness, ecchymosis, ED
cushing syndrome
155
villous atrophy
celiacs
156
celiac Ab testing
IgA things (anti-transglutaminase/endomysial) may be negative because celiacs is a/w IgA deficiency
157
RFs for aspergillosis
immunocompromise (invasive)
| hx of pulm dz (TB) (chronic)
158
what to expect in acute liver failure
AST/ALT crazy high
encephalopathy
INR > 1.5
renal failure
159
possible earliest sign of sickle cell
dactylitis (hand-foot syndrome)
| symmetric hand/foot swelling @ 6 mo to 4 yrs
160
wtf is pseudocyesis
psych pregnancy
pregnancy sx, thinks test is +
usually following loss or infertility
161
small platelets in repeatedly sick baby (+path)
wiskott aldrich (impaired cytoskeleton stuff)
162
which immunodef has impaired class switching
hyper IgM
163
type of syncope from pooping
situational (cardioinhibitory)
164
pertussis ppx: close contacts
macrolide x 5 days
| < 1 mo = azithromycin
165
dx: fibromuscular dysplasia
CT angio abdomen
166
mgmt: neurogenic bladder
clean intermittent catheterization q 4 - 6 hrs
167
which is worse sessile or pedunculated colon polyps
sessile
168
gait dysfxn, left sided weakness, HA worse in the AM
brain tumor
169
SAAG: how and why
serum alb - fluid alb
> 1.1 = portal HTN (RHF, cirrhosis)
< 1.1 = other (TB, renal)
170
Leriche syndrome
PAD of aorta into common iliacs
| claudication, impotence, LE atrophy
171
what fluids to give SIADH pts
mild (Na > 120) usually just fluid restrict
| severe (< 120) need hypertonic soln with osm > urine osm
172
osm of IVFs
NS (300)
| 1/2NS (150)
173
the sleep problem austin apparently has
delayed sleep phase syndrome
174
tx: brain mets
single: resect, then whole brain radiation
multiple: whole brain radiation
175
EGD: discreet ulcers surrounded by normal mucosa (mid esophagus)
think pill esophagitis
176
RSV complications
apnea (esp < 2 mo)
| resp failure
177
ppx: RSV
palivizumab
178
when to give RSV ppx
premie < 29 wks
chronic lung dz of prematurity
hemodynamically significant congenital heart dz
179
ddx single lytic bone lesion + hypercalcemia in kid
neoplastic (Ewing, langerhans, mets)
180
DMD vs BMD
DMD more severe (absent dystrophin)
| DMD < 5 yo
181
tx: ureteral stone
tamsulosin (relaxes ureteral muscles)
182
suppurative thyroiditis thyroid levels
euthyroid
183
which thyroiditis is painful
subacute (de Quervain)
184
thyroid stuff with TPO Ab
hashimoto
| painless
185
thyroid stuff with elevated ESR/CRP
subacute (de Quervain)
186
how do you know if natremia is hypotonic or hypertonic
serum osm < 275 = hypo
| serum osm > 275 = hyper
187
SIADH expected levels
```
usually euvolemic
UNa > 40
serum uric acid low
K normal
acid base is normal
```
188
meds causing SIADH
carbamazepine
SSRIs (esp old folk)
NSAIDs
189
signs of sepsis post burns
change in appearance (partial --> full thickness)
SIRS things
AMS
190
MC orgs: burn infections
immediate: staph
| > 5 days: gram negs (pseudomonas) or fungi (candida)
191
HCV, purpura, hematuria, proteinuria, low complement
cryoglobulinemia
192
bone x ray: moth eaten
```
ewings sarcoma (kid)
fibrosarcoma (adult)
```
193
bone x ray: fusiform defect w/ scalloping
chondrosarcoma
194
bone x ray: central lytic lesion w/ surrounding sclerosis
osteomyelitis
195
subungual tumor
glomus tumor
196
when do you worry about undescended testicles
bilateral and or
| > 6 mo
197
complications of cryptorchidism
```
subfertility (early is better)
testicular cancer (prepubertal is better)
testicular torsion (do orchiopexy)
inguinal hernia (defect fixed during repair)
```
198
internuclear ophthalmoplegia
one eye doesn't adduct, other abducts with nystagmus
lesion of medial longitudinal fasciculus
a/w MS (bilateral)
199
most specific test for ankylosing spondylitis
x ray
200
MC arrhythmias immediately after MI
reentrant ventricular arrhythmias
201
high leukocyte alkaline phosphatase score
leukemoid rxn
202
low leukocyte alkaline phosphatase score
CML
203
hexagonal crystals on UA and positive nitroprusside test
cystinuria
204
when do you do colonoscopy for UC pts
8 years post dx, then q 1 - 2 yrs
205
when do you colonoscopy for HNPCC pts
strt @ 20 - 25
| q 1 - 2 yrs
206
how do you know if its an arterial or neuropathic ulcer
arterial on tips of toes
| neuropathic under bony prominences, punched out
207
when can you see V/Q mismatch
PE
| pneumonia
208
TTP pentad
```
thrombocytopenia
hemolytic anemia
renal insufficiency
neuro
fever
```
209
persistent leg swinging after DTR test
```
muscle hypotonia (pendular reflexes)
see in cerebellar dz
```
210
ataxia, nystagmus, intention tremor/dysmetria
cerebellar dysfxn (EtOH)
211
b/l cordlike thickening of breasts
fibrocystic changes
212
tx: fibrocystic changes
NSAIDs or OCPs
213
complications of shoulder dystocia post delivery
Erb Duchenne
| Klumpke palsy
214
what is klumpke palsy
damage to C8 T1
claw hand
horner
intact moro + biceps reflex
215
back pain, normocytic anemia, lytic lesions
MM
216
temp for heat stroke
> 40.5 (105)
217
who's most likely to have weird ACS presentations
women
old
DM
218
macrosomia, macroglossia, big arms/legs (hemihyperplasia), and hernia/omphalocele
Beckwith-Wiedemann syndrome
219
complications of Beckwith-Wiedemann syndrome
hepatoblastoma
| Wilms tumor
220
peripheral blood smear in someone with splenectomy (or auto)
Howell-Jolly bodies
221
effects of E on thyroid things
up TBG
| need more levo if hypothyroid
222
post transplant ppx
TMP-SMX
| ganciclovir
223
AEs of levo/carbidopa
confusion, somnolence, hallucinations
| dyskinesia (late)
224
RF for warfarin skin necrosis
protein C def
225
chemo effects on lady hormones
transient amenorrhea
| ovarian failure happens earlier
226
rapid upstroke and rapid collapse pulse
AR
227
cells with periodic acid Schiff (PAS) positive material
think Whipples
| + lymphoblasts (ALL, CLL)
228
TdT
ALL
229
Auer rods
AML
230
leukemia after benzene exposure
AML
231
things that spark intussusception
meckel's
| Peyer patch hypertrophy
232
miscarriage and thyroid things
anti-TPO a/w miscarriage (hashimoto + painless thyroiditis)
| ppx with levo
233
auscultation things for pneumo
hyperresonance to percussion
diminished breath sounds
decreased tactile fremitus
decreased venous return (hTN)
234
HIV: fever, cough, diarrhea, splenomegaly, high alk phos
MAC
235
complication of full thickness burns
constrict venous/lymph drainage --> compartment syndrome
236
pain worse with bladder filling or sex and relieved by voiding
interstitial cystitis
237
PE --> what heart stuff
RBBB, right heart strain
238
pain over area previously affected by stroke
thalamic pain syndrome
| allodynia
239
pneumonia: what side to lie on and why
pneumonia side up
gravity increases blood flow (intrapulmonary shunting)
want blood going to good part of lung
240
morbilliform exanthem
adult parvo
| measles
241
contraindications to amnioinfusion
hx of uterine surgery
242
birth plan with hx of vertical c section or open myomectomy
planned c section @ 36 - 37 wks
| laparotomy + hysterotomy if labor earlier
243
hypokalemia sx
fatigue, weakness, cramps, hyporeflexia, arrhythmias
244
dyspnea, swollen head/neck
SVC syndrome
245
TSS: describe rash
diffuse, macular rash
| includes palms, soles
246
halos around lights
acute angle glaucoma
247
tx: wegners
corticosteroids
| cyclophosphamide or rituximab
248
urate crystals in soft tissues
tophi
| gout
249
continued ear drainage despite abx
think cholesteatoma
250
workup: 1st DVT
cancer screening
| inherited coag only looked into if v young or fam hx
