uworld 7 Flashcards
What meds can cause constipation?
numerous but esp anticholinergics. Hypothyroidism also can cause
How does amoxicillin type rash in EBV mono appear?
Occurs 24 hrs usually after taking drug, appears of polymorphous maculopapular rash.
How tx neutropenic fvr?
W/ broad spectrum ABX including P.A. coverage (i.e. cefepime, carbapenems, quinolones) usually quinolone + beta lactam
How prevent contrast induced nephropathy?
IV hydration needed, prevents renal vasoconstrxn and tubular injury, also nacetyl cysteine provides benefit
How differentiate asthma and COPD?
asthma reversible w/ bronchodilator while COPD is partially or non-reversible
Tx for asthma vs COPD?
inhaled steroids better for asthma but inhaled anticholinergics preferred for COPD.
Si/sx of sarcoidosis?
commonly AA women - > arthritis, lungs px w/ cough, dyspnea, fever, weight loss. Skin px w/ erythema nodosum, eyes px w. anterior uveitis,
CXR findings w/ sarcoidosis?
bilateral hilar adenopathy and reticular opacities
most common cause of hepatic cirrhosis?
ETOH abuse, viral hepatitis, NAFLD
Cause of wilson’s disease?
AR disease w/ deficiency of copper binding enzyme that fails to bind Cu or excretion onto ceruloplasmin
Lab finding w/ wilson’s?
low ceruloplasmin, low serum Cu, high urine Cu
What is hepatic whitlow?
self limiting viral infxn of hand due to HSV1 or HSV2 that px w/ redness, tenderness, vesicles.
Positive tzack smear px as?
multinucleated giant cells which suggests herpes infxn
Si/sx of disc prolapse?
unilateral radicular pain in dermatomal distrib., back spasm w/ inability to valsalva.
Si/sx of cauda equina syndrome?
bladder atony w/ overflow incontinence, bilateral sciatica, saddle anesthesia, loss of anal sphincter tone
Si/sx of acute bronchitis?
wheezing, afebrile, coag of acute onset, productive of yellow sputum, may be blood tinged
What is senile purpura?
ecchymosis in elderly in areas susc to trauma, due to atrophy of perivascular CT, no prior bleeding probs in hx
How does digoxin toxicity prx?
N/V, anorexia, confusion, weakness, visual abnormalities
What are indications for surgery w/ aortic stenosis?
syncope, angina, dyspnea, operation of choice is valve replacement
How w/u dysphagia?
If of solids + liquids- likely motility issue, do barium 1st, endo 2nd if inconclusive
What prophylaxis against malaria used in L.A. & Korea
Primaquine ( no falciparium in this region)
What prophylaxis used where falciparum resistant to chloroquine?
can use atovaquone-proguanil, doxy, mefloquine. Needed in subsaharin Afric, SE Asia, southern Asia
If noncaseating granuloma on lung biopsy? How tx?
sarcoidoiss most likely. tx w/ steroids
How does cyclosporine fxn?
inhibits IL-2 mainly, also inhibits other cytokines and helper T cells
Adv rxn of cyclophosphamide?
nephrotoxic - > htn, neurotoxic (HA, seziures, vision probs), hyperglyc, SCC + lymphoprolif malignancy, gingival hyperplasia, GI sx
Adv rxn of azathioprine?
dose-related diarrhea, leukopenia, hepatoxicity
How does obstructive PFT flow loop appear?
rapid incr in expiratory pressure with rapid fall, producing steep downward slope, like backwards J
How does restrictive PFT flow loop appear?
slower rise in expiratory pressure with slower linearly dcrs in pressure upon expiration< like upside down V.
What is BNP correlate w/?
level of circulating BNP - > severity of left ventricle filling pressure + mortality. Assoc w/ S3 when elevated.
How does HOCM murmur sound?
heard on left sternal border, cresc-descres murmur, due to interventrical septal hypertrophy
How differentiate HOCM from AS?
AS px on R sternal border and radiates to carotids, HOCM rare in young individuals w/out FMHX
Concerning signs for lymph node?
hard, immobile, non-rubbery, >2 cm
best tx for poor appetite in cancer pt?
progesterone analog megestrol acetate and medroxyprogesterone, also steroids
ACLS protocol for vfib, vtach?
first defib, then epi w/ 3 min CPR, repeat defib, give antiarryhtmics
how does OD on beta blockers px? How tx?
bradycardia, AV block, hypotension, diffuse wheezing. Tx w/ glucagon (incrs cAMP levels)
Risk of TCA OD and how tx?
can cause QRS prolongation leading to ventric arrythm, tx w/ Na bicarb - > depresses action of sodium channels preventing QRS prolong
What is source of bleed in mallory weiss tears?
Ruptured submucosal arteries
Px of cluster headaches?
tearing, pain of ipsilateral eye, horner’s syndrome, runny nose
How tx w/ ppx against cluster HA?
Can do verapamil, lithium, ergotamines
How does warfarin skin necrosis appear?
get pain then bullae then skin necrosis 2/2 to warfarin admin
Lab findings w/ low vitamin D?
get low Ca, low Phos, high PTH
What do low complement levels most often suggest w/ renal disease?
PSGN, lupus nephritis, MPGN, mixed cryoglobulinema (2.2 to hep C)
Effect of beta blocker admin in presence of pheo?
rapid incr in bp due to reflexive vasoconstrxn due to excessive alpha receptor activation, alpha receptor catechol are then unopposed (vasoconstrxn)
Most likely murmur w/ IV drug use?
tricuspid regurg which px w/ systolic murmur that incrs w/ inspiration
What is hazard rate?
chance of an event occuring in either tx arm or control arm over set period.
What is hazard ratio?
chance of event in tx arm cmprd to chance in control arm.
What does hazard ratio # mean?
If 1 then more likely in tx arm
Best tx for worsening pain in pt w/ prsotate cancer + metastasis?
best to use prophylactic radiation
Another tx for bone pain 2/2 to metastisis esp in prostate cancer?
can use bisphosphonates to dcrs bone dstrxn.
Si/sx of spinal cord compression?
worsening of local back pain, pain worse laying down, symmetric LE weakness, dcrsd reflexes, early bilateral babinski, incrsd dtr w/ sensory loss late.
How tx spinal cord compression?
emergent MRI, IV steroids
Risk w/ recurrent vomiting?
mallory weiss tear can form — ruptured submucosal arteries of distal esoph and prox stomach
How tx mallory weiss tear?
usually bleed stops spont., can tx w/ vasopressin, edoscopic injx, electrocautery
Si/sx of adrenal failure?
anorexia, fatigue, N/V/D, ab pain, weight loss, hyperpigmentation, dcrsd BP, dcrsd Na, incrsd K
How does reactivation of TB appear on CXR?
upper lobe infiltrate w/ cavitation
How does PCP penumonia appear on CXR?
diffuse granular opacities
How does otitis externa px typically?
Ear discharge and pain w/ pulling on Pinna
Most common organism w/ endocarditis 2/2 IV drug abuse?
staph aureus most common
What does an S4 heart sound signify?
heard over cardiac apex in left lateral decubitus position in pts w/ reduced ventricular compliance. Caused by htn, HD, AS, HOCM
Si/sx of syncope due to arrhythmia?
sudden nset w/ no preceding clues, presence of HD (post MI, MR), presence of arrythmia/ ectopic beats
What is flutamide?
non-steroidal antiandrogen that blocks androgen stimulation on prostate. Prolongs survival in pts w/ prostate cancer
Common cause of ascites?
cirrhosis, acute liver failure, ETOH hepatitis, budd-chiari, HF, hypoalbuminemia, nephrotic syndrome
Peritoneal cause of ascites?
malignancy or infxn
What is pathophys of goodpastures?
Ab agaisnt alpha 3 chain of type IV collagen — expressed most in alveoli and glomeruli
Si/sx of aortic regurg?
water hammer pulse — wide pulse pressure felt by pt as pounding heart
Typical cause of nec fasc
usually occurs after trauma
How does nec fasc px?
bullae, serosang in area of edema & purpulish discoloration, exquisit tenderness, si/sx of shock also may be px
Painless hard mass in testes?
do radical orchiectomy w/out other studies, dont do FNA as risk for seeding of tumor cells.
What is post-chole syndrome?
persistent abd pain/ dyspepsia that happens postop or years later after cholecystectomy
What are causes of PCS?
can be biliary or extrabiliary cause… due to retained stone or biliary dyskinesia
Important side effects of HIV therapy?
Indinavir causes crystal induced nephropathy, didanosine — pancreatitis, abacavir - hypersen syndrome, NRTIs – lactic acidosis, neviropine – liver failure, NNRTIs- SJS
How does nocardia px? How tx?
acid fast G+ branching rods. tx w/ TMP-SMX
How does nocardiosis px?
usually in immunocomprom pts, px w/ weight loss, fvr, night sweats, cough w/ productive sputum
How does nocardia appear on cxr?
lobar or multilobar consolidation, can px w. solitary mass or nodules
What is confounding?
when exposure disease relationship is combined w/ another factor skewing or confusing results
What is selection bias?
refers to method w/ which ppl are picked in study or if particular groups fail to follow up
Si/sx of complication of infective endocarditis?
arterial emboli - focal neuro probs, visceral organ infarcts, mycotic aneurysms,
Si/sx of infective endocarditis?
conjunctival hemorrhages, GMN, janeway lesions — rash on palms soles, osler nodes- painful vesicles on fingers, toes
Main CSF finding w/ MS?
oligoclonal bands, mainly IgG, altho may be IgA, IgM
Where would pure motor stroke px?
most likely internal capsule - > lacunar stroke
What causes of reanl insufficiency in multiple myeloma?
likely obstrxn of distal & collecting ducts by laminated casts of bence jones proteins
What is klebs penumonia?
G- capsulated bacilli, usually affects infants, elderly, alcoholics, neutropenic/immunocomp pts, most common cause of CAP in ETOH
how does syringomyelia appear on CT/MRI?
cord cavity usually in upper thoracic/ lower cervical spine
Px of CMV retinitis?
painless w fluffy or granular retinal lesions located near the retinal vessels.
How does HSV infxn in eye px?
eye pain, conjunctivitis, rapid visual loss, fundo shows nuemrous pale perih retinal lesions w/ central retinal necrosis
CHF findingins on ABG?
hypoxia, hypocarbia, respiratory alkalsosis
what testing should be done to asses HF?
BNP and PCWP
How does aspirin cause gastritis?
inhibits protective prostacycline prodxn, can lead to hemorrhagic erosive lesions
How does subarrachnoid hemorrhage px?
svr HA, dcrsd level of conciousness, no focal findings
What is px of cerebellar hemorrhagic stroke?
ataxia, vomiting, occipital HA, gaze palsy, facial weakness, no hemiparesis
What is hepatic hydrothorax?
pleural effusion, assoc w/ portal htn usually on R side w/ no underlying cardiac or pulmonary issue
How tx hepatic hydrothorax?
- pleurodesis + diuresis, 2. if fails do xplntation or TIPS
How does cerebellar tumor usually px?
ipsilateral ataxia!!!, nystagmus, intention tremor, problems w/ repetitive movements
What genetic findinings alter tx for breast cancer?
If oncogene px (HER2) can tx w/ trastuzumab
What is lumbar spinal stenosis?
degen condition w/ narrowing of canal. Due to enlarging osteophyte and hypertrophy of ligamentum flavum.
Px of lumbar spinal stenosis?
pain in butt/thigh, worse w/ extension, walking, improvement w/ flexion of spine, if was due to lumbar disc herniation, flexion worse not better
How w.u likely PE based on sx?
- start anticoag on heparin. 2. do CT or V/Q scan to confirm. 3. If + do thrombolytics +/- surgry, if - stop anticoag.
Waht is risk w/ chronic alcoholism?
recurrent gout. If get gout should abstain, avoid purine in diet, avoid diuretics and pyrazinamide
WHat drugs precipitate renal damage?
NSAIDS, ACEI, cyclosporine
WHat is cause of AKI?
renal blood flow dcrsd to point that toxins like BUN, Cr build up and cause damage
What are vascular causes of AKI?
Renal artery occlusion, TTP, HUS
