UWorld 4 Flashcards
1
Q
osteoporosis nonmodifiable RF
A
- advanced age
- postmenopausal
- low body weight
- white or asian
- malabsorption disorders
- hypercortilism, hyperthyroidism, hyperparathyroidism
- inflammatory d/o (RA)
- chronic liver or renal dz
2
Q
osteoporosis modifiable RF
A
- smokin
- excessive alcohol intake
- sedentary lifestyle
- meds (GC, anticonvulsants)
- Vit D deficiency, inadequate calcium intake
- estrogen deficiency (eg premature menopause, hysterectomy/oophorectomy)
3
Q
Paget dz of bone
A
- characterized by osteoclast dysfunction with a focal increase in bone turnover
- most pts are asymptomatic, but s/s may include skeletal deformities, bone pain, and fractures
- involvement of cranial bones may lead to HA and hearing loss
4
Q
hypertrophic osteoarthropathy
A
- suggested by development of clubbing and sudden-onset jt arthropathy in a chronic smoker
- often assoc with lung ca, and therefore a CXR is indicated to rule out malignancy and/or other lung path
5
Q
S3
A
- low frequency diastolic sound heard just after S2 that is associated with LV failure
- iv diuretics provide symptomatic benefits to pts with decompensated HF
6
Q
OPP poisoning
A
- inhibits acetylcholinesterase leading to s/s of CHOLINERGIC excess including: bradycardia, miosis, rhonchi, muscle fasciculations, salivation, lacrimation, urination and defecation.
- atropine administration can reverse these effects
- also: remove clothes and wash skin to prevent further transcutaneous absorption
7
Q
spinal osteomyelitis
A
- tenderness to gently percussion over the spinous process of the involved vertebra is the most reliable sign
- pain not relieved with rest
- fever and leukocytosis and unreliable findings
- EST is grossly elevated
- MRI is most sn diagnostic study
- there should be avery high index of suspicion for vertebral osteomyelitis in pts w/ a h/o IVDU or recent distant site infection (UTI)
8
Q
clinical features of analgesic nephropathy
A
CP:
- associated with long term use of 1 or multiple analgesics (ASA, ibuprofen) for chronic HA or other somatic complaints
- usually asymptomatic but can have chronic tubulointerstitial nephritis or hematuria d/t papillary necrosis
diagnosis:
- elevated Cr with UA showing hematuria or sterile pyuria
- can have mild proteinuria (<1.5g/d)
- CT scan show small kidneys with b/l renal papillary calcifications
9
Q
methanol intoxication
A
most severe consequences are vision loss and coma
- PE: optic disc herniation while labs show anion gap met acidosis
- also often see an osmolar gap as well
10
Q
what is the most common cause of inadequate response to ESAs in pts on dialysis
A
iron deficiency
11
Q
when are PDE-5 inhibitors contraindicated
A
in pts taking nitrates or alpha blockers as concomitant use can cause severe hypotension
12
Q
acute exacerbation of COPD is characterized by a change in >/=1 of the following:
A
- cough severity or frequency
- volume or character of sputum production
- level of dyspnea
13
Q
alpha1-R blockers and stone impaction
A
- ones like Tamsulosin act on the distal ureter, lowering muscle tone and reducing reflex ureteral spasm 2/2 stone impaction
- these agents facilitate stone passage and reduce the need for analgesics
14
Q
ppx criteria for Lyme dz (must meet ALL 5)
A
- attached tick is an adult or nymphal Ixodes scapularis (deer tick)
- tick attached for >/=36hours or engorged
- ppx started within 72 hrs of tick removal
- local borrelia burgdorferi infection rate >/=20% (eg New England area)
- no contraindications to doxy (eg age<8, pregnant, or lactating)
15
Q
amiodarone and pre tests
A
- pulm toxicity is a serious SE of long-term amiodarone use that can occur months to several years after the initiation of amiodarone therapy
- baseline chest radiograph and PFT should be obtained prior to initiating therapy with amiodarone
16
Q
alpha 1 AT deficiency
A
- should be considered in pts who lack typical RF for COPD (eg age=45) or those with atypical features (basilar-predominant dz)
- diagnosis is confirmed by measuring serum AAT levels
17
Q
ascending aortic aneurysms
A
- most often due to cystic medial necrosis or CTD
- descending aortic aneurysms are usually d/t atherosclerosis
- CXR can suggest thoracic aortic aneurysm by showing a widened mediastinal silhouette, increased aortic knob, and tracheal deviation
18
Q
management of Zenker diverticulum
A
- open/endoscopic sx
- cricopharyngeal myotomy
19
Q
pacemaker
A
transvenous lead placement through tricuspid valve can cause severe tricuspid regurg d/t direct valve leaflet damage or inadequate leaflet coaptation
-this complication should be suspected in pts presenting with r-sided HF following implantable pacemaker or cardioverter-defribillator placement
20
Q
major risk factors for acute urinary retention
A
- male sex (AUR rarely occurs in women)
- advanced age (approx 33% of men age>80 will develop AUR)
- h/o BPH
- h/o neurologic dz (mild cognitive impairment)
- sx (especially abdominal sx, pelvic sx, and joint arthroplasty)
21
Q
HACEK
A
- Haemophilus aphrophilus
- Aggregatibacter actinomycetemcomitans (previously actinobacillus actinomycetemcomitans)
- Cardiobacterium hominis
- E corrodens
- Kingella kingae
responsible for only 3% of IE cases
22
Q
fibromyalgia
A
- pain syndrome that occurs most commonly in young to middle-aged women and is characterized by fatigue, widepsread pain, and cognitive/mood disturbances
- amitriptyline is an effective initial therapy
- Pregablin, duloxetine, and milnacipran are alternate therapies for pts not responding to tricyclic antidepressants
23
Q
platelet dysfunction and chronic renal failure
A
- plt dysfunction is the m/c c/o abnml hemostasis in pts with CRF,
- PT, PTTm and plt ct are nml; BT is prolonged
- DDAVP is usually the tx of choice if needed
24
Q
metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:
A
- abdominal obesity (men waist circumference >40 inches; women: waist circumference >35 inches)
- fasting glucose >100-110 mg/dL
- BP>130/80 mmHg
- TG >150 mg/dL
- HDL cholesterol (men: <40mg/dL; women <50 mg/dL)
25
hepatic hydrothorax
- results in transudative pleural effusions and is thought to occur d/t small defects in the diaphragm
- diagnosis involved documentation of the effusion and testing to exclude other causes
26
ischemic hepatic injury
- occurs in the setting of hypoTN and manifests as acute, massive increases in the transaminases with milder associated increases in the total bilirubin and alk phos
- in pts who survive the inciting condition (eg hypoTN), liver enymes typically return to nml within a few wks
27
possible features of BCC include:
- persistent open sore that bleeds, oozes, or crusts
- reddish patch or irritated area (superficial BCC)
- pearly or translucent nodule with pink, red, or white color (nodular BCC)
- elevated or rolled border with central ulceration
- pale scar-like area with poorly defined borders
28
SCC
most common skin malignancy in pts on chronic immunosuppressive therapy for a history of organ transplant
-SCC in immunosuppressed pts is more aggressive with an inc r/o local recurrence and regional mets
29
syncope in a young pt
- with a crescendo-decrescendo murmur at the lower left sternal border is most likely d/t HOCM
- syncope in HOCM is often multifactorial and can be due to outflow obstruction, arrhythmia, ischemia, and a ventricular baroreceptor response that inappropriately causes vasoDILATION
30
abdo US and AAA
-abdo US is study of choice for diagnosis and f/u of AAA--nearly 100% sn and sp
31
panendoscopy
triple endoscopy=esophagoscopy, bronchoscopy, laryngoscopy
32
cyanide and LA
- cyanide binds to ferric iron in cytochrome oxidase a3 in the mitochondrial ETC
- this activity blocks oxidative phosphorylation and promotes anaerobic metabolism, causing lactic acidosis
33
heparin-induced thrombocytopenia
-should be suspected in pts receiving heparin anticoagulation who have thrombocytopenia, thrombosis (arterial or venous) or a >50% drop in the plt ct from baseline 5-10d after the initiation of treatment
34
bath salts
- have amphetamine properties that can cause severe agitation, combativeness, delirium, and psychosis
- tachycardia is often present
- takes up to a week to subside
35
randomization in clinical trials
-successful when a similiarity of baseline characteristics of the pts in the tx and placebo groups is seen
36
manifestations of pulmonary embolism
- nonspecific and variable
- diagnosis should be suspected in any pt who presents with some combo of sudden-onset SOB, pleuritic CP, low-grade fever, and hemoptysis
- tachypnea, tachycardia, and hypoxemia are common exam findings
37
three main categories of diabetic nephropathy
1. background or simple retinopathy-consists of microaneurysms, hemorrhages, exudates, and retinal edema
2. pre-proliferative retinopathy-with cotton wool spots
3. proliferative or malignant retinopathy-consists of newly formed vessels
38
hypersensitivity pneumonitis
- inflamm of the lung parenchyma caused by antigen exposure
- acute episodes: cough, breathlessness, fever, and malaise that occur within 4-6hr of antigen exposure
- chronic exposure may cause weight loss, clubbing, and honeycombing of the lung
- cornerstone of management is avoidance of the responsible antigen
39
delayed sleep-wake phase disorder
- circadian rhythm disorder characterized by the inability to fall asleep at traditional bedtimes=sleep-onset insomnia and excessive daytime sleepiness
- pts sleep normally if allowed to follow their internal circadian rhythm and sleep until late morning
40
solitary pulmonary nodules factors increasing malignant probability
- large size (size >2cm independently correlates with >50% malignant probability)
- advanced pt age
- female sex
- active or previous smoking
- family or personal h/o lung ca
- upper lobe location
- spiculated radiographic appearance
41
hypoventilation, post-ictal state
acidosis accompanied by hypercarbia and a nml or elevated serum bicarb is diagnostic of a respiratory acidosis
-hypoventilation is a major cause of respiratory acidosis and may occur in the post-ictal state
42
postoperative endophthalmitis
- m/c form of endophthalmitis
- usually occurs within 6 weeks of sx
- pts usually present with pain and dec visual acuity
- exam: swollen eyelids and conjunctiva, hypopyon, corneal edema and infection
