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
