Uworld Flashcards
1
Q
Wallenberg syndrome
A
Right side lateral medullary infarction
Occlusion of post inf cerebellar or vertebral artery
-vertigo, nystagmus
-ipsi face and contra trunk loss of pain and temp
-hoarse, dysphagia, dysarthria
-Horner’s syndrome
2
Q
Nasopharyngeal carcinoma
A
Reactivation of EBV
Assoc with asia, africa, middle east
-nasal congestion with epistaxis, HA, CN palsies, otitis media, cervical LN spread
3
Q
Amiodarone side effects
A
Antiarrhythmic for ventricular probs
- thyroid probs, hepatotoxicity, bradycardia, heart block, neuro and vision probs
- pulmonary toxicity (interstitial pneumonitis)
- blue/gray skin
4
Q
Post-op Atelectasis
A
Hypoxemia, hypocapnia, respiratory alkalosis
5
Q
Methotrexate side effects
A
DMARD
Give with folate
Side effects: gastrointestinal symptoms, oral ulcers or stomatitis, rash, alopecia, hepatotoxicity,
pulmonary toxicity, and bone marrow suppression (macrocytic anemia, leukopenia,
thrombocytopenia)
6
Q
Initial management of massive hemoptysis
A
Establish patent airway
Maintain adequate ventilation and gas exchange
Keep hemodynamically stable
Place patient in dependent (lateral) position
Bronchoscopy for early intervention
7
Q
Earliest renal abnormality in a diabetic patient
A
Glomerular hyperfiltration (ACEi super important to reduce intraglomerular hypertension) Thickening of the BM is the first quantifiable change
8
Q
Provoked DVT risk factor and treatment
A
Risk factor: major surgery, long periods of sitting
3 months of anticoagulation
If stable, start in 48-72 hours
Heparin (goal INR (2-3) then bridge to warfarin
(No LMWH if ESRD patient (metabolized by kidney), use IV unfractionated instead)
9
Q
Prepatellar bursitis
A
“Housemaid’s knee”- repetitive kneeling
Due to Staph aureus infection
10
Q
Complications after cardiac cath
A
bleeding, hematoma (localized or with retroperitoneal extension), arterial dissection, acute
thrombosis, pseudoaneurysm, or arteriovenous fistula formation
11
Q
S/p cardiac cath, now hemodynamically unstable with back/flank pain
Next step?
A
Retroperitoneal hematoma
Non con CT A/P or U/S
Bed rest, fluids, ICU
12
Q
Vitamin D toxicity
A
Super high doses
N/V, confusion, polyuria, polydipsia
13
Q
Multiple Myeloma
A
Plasma cell neoplasm- excessive production of a single Ab
Bone pain, hypercalcemia, anemia, renal insufficiency, increased risk of fractures and infections
(hypogammaglobulinemia)
14
Q
When to get a cholecystectomy?
For acute cholecystitis, choledocholithiasis, gallstone pancreatitis
A
Within 72 hours
15
Q
When to get a cholecystectomy?
Gallstones with/without colic symptoms
A
With: elective
Without: no tx
16
Q
Causes of hypoventilation with respiratory acidosis
A
Pulmonary/thoracic diseases: Chronic obstructive pulmonary disease, obstructive sleep apnea,
obesity hypoventilation, scoliosis
Neuromuscular diseases: Myasthenia gravis, Lambert-Eaton syndrome, Guillain-Barré syndrome
Drug-induced hypoventilation: Anesthetics, narcotics, sedatives
Primary central nervous system dysfunction: Brainstem lesion, infection, stroke
17
Q
Uncal Herniation
A
Contralateral cruz cerebri- ipsi hemiparesis
Ipsi oculomotor n.- mydriasis, ptosis, down and out gaze
Ipsi post cerebral a.- contra homonymous hemianopsia
Reticular formation- AMS, coma
18
Q
Most common tendinopathy with fluoroquinolone use
A
Achilles
19
Q
Malaria symptoms
A
Cyclical fever: cold, hot, sweating phases
Anemia, thrombocytopenia
GI and nonspecific symptoms
20
Q
Malignant PTH-independent hypercalcemia
A
Humoral hypercalcemia of malignancy: SCC- PTHrP; 1,25 vit D levels low/normal Osteolytic bone mets- bony destruction Lymphoma- incresed 1,25 Vit D Multiple Myeloma- increased IL-6
21
Q
Costocochondritis ssx and tx
A
Tenderness of 1+ rib or sternum joints
Sharp reproducible pain with palpation
Reassurance and OTC pain meds
22
Q
Systemic Sclerosis symptoms
A
Thick, hard, edema, pruritis skin
GI, joint and respiratory problems
Smooth muscle atrophy and fibrosis of lower esophagus
23
Q
Malignancy red flags
A
Anorexia, weight loss, systemic symptoms
24
Q
Epigastric Pain: Pancreatic cancer v. Duodenal ulcer
A
P: constant, gnawing, worse at night, anorexia, weight loss, jaundice
D: episodic, relieved by meals
25
Most common hypercoagulable disorder
Factor V Leiden
| Prothrombin mutation
26
Hereditary Hemochromatosis
Bronze diabetes
Hepatomegaly
Calcium pyrophosphate dihydrate crystal deposition
-chondrocalcinosis, pseudogout, chronic arthropathy
Get iron studies
27
Anterior uveitis symptoms, findings, causes
Painful, red eye, tearing, photophobia, decreased visual acuity
ciliary flush, pupillary constriction, a hazy "flare" in the aqueous humor, and hypopyon
Idiopathic, traumatic, systemic inflammatory disease
28
Inheritance of hypertrophic cardiomyopathy
Autosomal dominant
29
Signs of severe aortic stenosis
Pulsus parvus and tardus
Mid to late peaking murmur
Soft S2
30
Mixed cryoglobulinemia syndrome
Immune complex deposition disorder- sm to med blood vessels
Associated with HCV
Fatigue, palpable purpura, arthralgias, renal disease, peripheral neuropathies
Lab: cyroglobulins, hypocomplementemia, +RA, inc. ALT/AST, kidney injury
31
Bowel dilation in small bowel obstruction v. Ileus
SBO- sm bowel only
| I- sm and large bowel
32
Crystal induced AKI
High dose IV acyclovir
24-48 hr after drug given
Crystalizes in renal tubules -> obstruction
Give with IV fluids
33
Lead poisoning
GI: abd pain, constipation
Neuro: forgetful, motor and sensory neuorpathies (stocking glove)
Microcytic anemia- basophillic stippling
Hyperuricemia
Batteries, manufacturing, plumbing, home distillation of alcohol
34
Angiosarcoma
```
internal lining of blood and lymphatic vessels
Exposure to radiation therapy (breast cancer) (may be 4-8 years later)
Chronic lymphedema (axillary LN resection)
```
35
Signs of complicated SBO
Need surgery
Change in pain, unstabe, peritoneal signs, metabolic acidosis, fail to improve after conservative
measures
36
Mesenteric Ischemia
Acute- embolism from cardiac valve vegetation/afib
Acute on chronic- atherosclerosis
Pain out of proportion to exam, meta acidosis, hemoconcentration, inc amylase
37
Late findings in Alzheimer dementia
Hallucinations, EPS, seizures, urinary incontinence, dyspraxia
38
Acalculous cholecystitis
Inflammation without stones
Post surgery, hospitalized, critically ill
GB stasis/injury
Fever, leukocytosis, RUQ pain, jaundice, +/- abnl labs
39
Frostbite treatment
Rapid rewarming with warm water (98.6-102.2F)
Agressive analgesia
Dont rewarm if refreeze is possible
40
ARDS
Fluid/cytokine leak into alveoli
Decreased compliance, impaired gas exchange (V/P mismatch)
Hypoxemia (PaO2/FiO2 <= 300)
Pulm HTN
41
Second degree AV block, Mobitz type I
Block at AV node
Progessively prolonged PR, then drop of QRS
Low risk of complete heart block
Observation, correct reversible causes (dig, BB, CCB)
42
Alcoholic Hepatitis
Fever, jaundice, anorexia, tender hepatomegaly
| AST x2 ALT (both less than 300)
43
Work up of elevated transaminases
History: risk factors for hepatitis (alcohol, travel, transfusions, high risk behavior, medicines,
drugs)
D/C alcohol and drugs, repeat labs in 6 months
Test for hep b/c, hemochromatosis, NAFLD, etc
Test for muscle or thyroid disorders
44
Treatment for acute glaucoma
Mannitol, acetazolamide, pilocarpine, timolol
| Avoid atropine
45
Side effects of loop diuretics
Hypokalemia, metabolic alkalosis, prerenal AKI
46
Bullous pemphigoid
Prodrome: uticarial or eczematous lesions
Pruritis and tense bullae
Dx: biopsy
Immunoflourescence linear IgG adn C3 along BM
Tx: high dose steroid
47
Sjogren Syndrome
Dry mouth and eyes
Lymphocytic infiltration of salivary glands
Ab against SSA (Ro) and/or SSB (La)
48
Supracondylar Fracture of the humerus
More common in kids
| Brachial artery and median nerve entrapment
49
Initial management of osteoarthritis
Weight loss, exercise, strengthen quads, NSAIDs
50
Treatment for cancer related anorexia/cachexia
Progesterone analogues > steroids
51
Differential diagnosis of cough, hilar adenopathy, erythma nodosum, non caseating granuloms
Sarcoidosis, Histoplasma, Blastomyces, Coccidioides
52
Nitrates mechanism of action
Vasodilators- veins, arterioles and coronary arteries
Decreased preload and left vent end diastolic volume
Reduces myocardial demand and wall stress
53
Zinc deficiency
Hypogonadism, impaired taste, impaired wound healing, alopecia, skin rash (can be around
mouth)
54
Primary Adrenal Insufficiency
```
Cortisol low
ACTH high
Aldosterone low
Severe symptoms (hyperpig, hyperK, hypoNa, hypoTN)
Autoimmune
```
55
Central Adrenal Insufficency
```
(Seconday/pit) (tertiary/hypothal)
Cortisol low
ACTH low
Aldosterone normal
Chronic steroid use
Less severe symptoms (no hyperpig, no hyperK, possible hypoNa)
```
56
Differential for unilateral hip pain in middle age adult
Infection, trauma, arthritis, bursitis and radiculopathy
57
Most common renal stone
Calcium stones
| Encourage low sodium diet to promote calcium reabsorption
58
Sphincter of Oddi cause and symptoms
```
Dyskenesia or stenosis
Postcholecystectomy RUQ pain
Recurrent colicky pain
Elevations in LFTs and Alk phos
Dilated bile duct/no stones
Opioids cause sphincter contraction
```
59
Signs of necrotizing fasciitis
```
Pain, edema, redness beyond surgical site
Fever, hypoTN, tachycardia
Parathesia, anesthesia on wound edges
Purulent, gray cloudy discharge
Gas or crepitus
```
60
Pt had blunt abdominal trauma now hypotensive, intraperitoneal fluid found on FAST, RUQ pain, bruising across abdomen and right shoulder pain
Liver laceration
| Shoulder pain due to phrenic nerve irritation
61
Whipple’s disease
Tropheryma whippelii
White men 50-60s
Arthralgias, weight loss, fever, diarrhea, abdominal pain
PAS+ in lamina propria of small intestine
62
Exam findings with a medial meniscus tear
Clicking, palpable locking or catching when joint is extended under load
63
Weight loss, jaundice, Courvoisier sign, intra and extra hepatic billiary tract dilation
Pancreatic cancer
Courvoisier sign: nontender, distended, palpable gall bladder on exam
64
Treatment of urgency incontinence
UA
Bladder training and pelvic floor exercises
Antimuscarinic drug
65
Work up for male with urinary frequency, nocturia and hesitancy
UA- hematuria/infection
| DRE/PSA- prostate
66
Lab results of G6PD deficiency
Lab results:
Low Hb, inc indirect bili, inc lactate dehydrogenase, dec haptoglobin
Neg Coombs
Bite cells
Wait 3 mo after an attack before testing enz activity
67
Side effect of normal saline
Hyperchloremic metabolic acidosis
68
Single subcapsular cyst on the right hepatic lobe found on imaging
Amebic liver abscess
Entamoeba histolytica- protozoan
Causes colitis
69
Porphyria cutanea tarda
Fragile, photosensitive skin, vesicles and bullae (dorsa of hands)
Scaring, hyper/hypo pig
Assoc. with HCV
Increased plasma and urine porphyrins
TX: serial phlebotomy, hyroxychloroquinone, HCV tx
70
Reason for anemia, leukopenia and thrombocytopenia in SLE
Anemia- chronic dx, Fe def, renal insufficiency, autoimmune hemolytic
L- autoimm destruction, meds, bone marrow dysfxn
T- immune mediated destruction, meds, TTP
71
Common causes of digital clubbing
Lung cancer, cystic fibrosis, right to left cardia shunts
72
Why is involvement of the the external ear more suggestive of erysipelas than cellulitis?
The skin of the external ear lacks a lower dermis level
| Cellulitis involves the deep dermis and subQ fat
73
Primary polydipsia v. SIADH
PP: serum osm <290, urine osm <100- more likely in psych patients
SIADH: serum osm <290, urine osm >100, urine Na >25- urine osm > serum osm
74
Four Ts of anterior mediastinal mass
Thymoma
Teratoma (and other germ cell tumors):
—seminomas: bHCG
—nonseminomatous: AFP and bHCG
Thyroid neoplasm
Terrible lymphoma
75
Signs of extraperitoneal bladder injury
Neck, anterior wall, anterolateral wall of bladder damaged
-localized pain, gross hematuria, +/- pelvic fracture
NO peritoneal signs
76
Varicocele, which side is more common?
Dilation of pampiniform plexus veins
“Bag of worms” soft irregular mass
Inc in size with standing and valsalva
More common on left due to compression of left renal vein by the SMA and aorta
77
Zollinger-Ellison Syndrome
Gastrin secreting tumor (>1000)
Duodenal, jejunal ulcers
Multiple peptic ulcers and diarrhea (panc enz inactivated by acid)
Assoc w/ MEN1
78
Labs of prerenal AKI
```
50% inc in Cr
Dec urine output
BUN:Cr >20:1
FENa <1%
UA is normal
```
79
Caustic poisoning
Cognition not as affected
Damage to GI lining
White tongue, heavy salivation, dysphagia
Watch out for GI perf 2/2 severe ulcers
80
Duodenal Ulcers
Pain worse on empty stomach, gnawing feeling
H. Pylori, NSAIDS
Tx: PPI and abx (amoxicillin + clarithromycin)
81
Bronchogenic Carcinoma
Asbestos exposure
| Pleural plaques with pulmonary fibrosis
82
Decompensated heart failure in younger patients
Dilated cardiomyopathy 2/2 viral myocarditis
83
What does hepatojugular reflex indicate?
A reflection of right heart failure
-constrictive pericarditis, right ventricular infarction, restrictive cardiomyopathy
Helps determine cardiac v liver cause of LE edema
84
Treatment for chronic lower back pain
Exercise therapy
85
Torus palatinus
Benign bony growth on midline of hard palate
Congenital
Young, women, asians
No tx unless ssx
86
Pt with ulcerative colitis needs screening for...
Colorectal cancer 8-10 yrs after initial diagnosis
87
Telogen effluvium
Non inflammatory hair loss
After pregnancy/birth, serious illness
Self limited
88
Osteonecrosis (aseptic) of the femoral head
Occlusion of end arteries
Assoc. with sickle cell disease, chronic steroid use
Progressive hip pain, limited internal rotation and abduction
Unremarkable x rays, normal inflammatory markers
89
Side effects of Cyclophosphamide
Hemorrhagic cystitis, bladder carcinoma, sterility, myelosuppression
90
Simple renal cyst characteristics and tx
Thin regular wall, unilocular, no septae, homogeneous, no contrast, assx
Reassurance
91
Imaging of choice for AAA
Abdominal U/S
92
Asthma v. COPD on pulmonary function testing
Asthma: >12% increase in FEV1 with bronchodilator, normal or increased DLCO
93
Heart compensation in hypovolemic shock
Decreased preload and CO —>
Inc SVR
Inc HR
Inc ejection fraction (LV is small)
Flat neck veins
94
Massive PE ssx and CV collapse
Hypotension, syncope, acute dyspnea, pleuritic chest pain, tachycardia, hypoxia
RV dysfunction 2/2 inc pulm vasc resistance
—RV dilation, inc O2 demand, dec coronary perfusion
95
Clinical Association:
| Focal segmental glomerulosclerosis
African American, Hispanic
| Obesity, HIV, Heroin
96
Clinical Association:
| Membranous Nephropathy
Adenocarcinoma, NSAIDs, Hep B, SLE
97
Clinical Association:
| Membranoproliferative glomerulonephritis
Hep B and C, lipodystrophy (abnormal fat distribution)
98
Clinical Association:
| Minimal Change Disease
NSAIDs, lymphoma
99
Clinical Association:
| IgA Nephropathy
Recent URI
100
Sound and positioning of Aortic regurg
Early decrescendo diastolic murmur when sitting up, leaning forward, hold breath in full expiration along left sternal border at 3 and 4th intercostal space with the diaphragm
101
Duodenal Hematoma
In kids, 24-36 hours after blunt abdominal trauma
Obstructive symptoms
NG decompression, parenteral nutrition
102
Cause of muscle weakness in cushing syndrome
Catabolic effects of cortisol on skeletal muscle—> muscle atrophy
103
Cause of hypercoagulability in nephrotic syndrome
loss of antithrombin 3, altered levels of C/S, increased platelet aggregation, hyperfibrinogenemia (inc hepatic synthesis), impaired fibrinolysis
104
Complications of Nephrotic syndrome
Hypercoagulable- renal vein thrombosis, PE
Protein malnutrition
Iron resistant hypochromic anemia-(transferrin)
Vit D deficiency- (cholecalciferol-binding prot)
Increased susceptibility to infection
105
Diaphragmatic rupture
2/2 trauma
Presentation can be delayed weeks-months (kids)
Mediastinal deviation, left diaphragm issues, bowel in the chest
Get CT
106
Pilonidal Disease
Young, obese, sedentary males
Fluctuant mass in the intergluteal region
Occluded infected hair follicle—> pilonidal sinus tract
107
Splenic Abscess
Fever, leukocytosis, LUQ pain
Left pleuritic pain/effusion
Splenomegaly
```
2/2 infective endocarditis, IV drug use, trauma, Hb-opathies
Septic emboli (staph, strep, salmonella)
```
108
Adhesive Capsulitis
Frozen shoulder
Reduction in passive and active ROM
2/2 chronic inflam, fibrosis and contracture
109
Anal fissures treatment
Fiber, fluid, stool softeners, sitz baths, topical anesthetics and vasodilators (nifedipine)
110
Rupture of which part of the bladder causes peritonitis
```
The dome
(Anterior wall and neck are extraperitoneal)
```
111
Most common complication of the flu
Pneumonia (influenza or strepneumo)
Also muscles, heart, CNS can be affected
112
Cause of abnormal hemostasis in chronic renal failure
Platelet dysfunction
PT, PTT, platelet count normal
Prolonged bleeding time
Desmopressin (DDAVP)- increases factor 8:vWill multimers from endothelial storage sites
NO platelet transfusion
113
Primary hyperaldosteronism labs
HTN
Hypernatremia (mild)
Hypokalemia
Metabolic alkalosis (losing H+, inc bicarb reabs)
114
Causes of post op fever
```
malignant hyperthermia, bacteremia
Wind (1): atelectasis, pneumonia
Water (3): UTI
Walk (5): DVT
Wound (7): wound
Wonder drugs
Abscess (10+)
```
115
Dermatomyositis
inflam myopathy
immune mediated
paraneoplastic
symmetric proximal muscle weakness plus rash on hands or face
116
Pulsatile groin mass below the inguinal ligament with anterior thigh pain
Femoral artery aneurysm
| Popliteal is also common, both assoc. with AAA
117
Treatment for acute hyponatremic encephalopathy
Hypertonic 3% saline, monitor electrolytes
118
Indications to start statin therapy
Clinically significant ASCVD
LDL >190
40-75 with diabetes
10 yr ASCVD risk >7.5%
119
Why do patients diagnosed with Myasthenia Gravis need a CT?
To look for an acetylcholine receptor antibody producing thymoma
120
Acute symmetrical arthralgias with mild synovitis primarily involving the small joints of the hand
Parvovirus B19
Self limited
Assoc with daycare centers
121
Lab findings in mesenteric ischemia
Leukocytosis
Hemoconcentration
Elevated Amylase
Metabolic acidosis (low bicarb)
122
Paget disease
```
Disordered osteoclastic bone resorption
Inc. Alk Phos, mixed osteolytic/sclerotic bone lesions
Bone enlargement, weakness, fracture
Frontal bossing, headaches, hearing loss
Tx: bisphosphonates (alendronate)
```
123
EKG: irregularly irregular rhythm with loss of P waves
Atrial fibrilation
124
Most common valve problem 2/2 rheumatic fever
```
Mitral stenosis (diastolic rumble)
70% with ms will develop afib because of left atrial enlargement
```
125
Lung cancers and paraneoplastic syndromes
Squamous cell: sCa++mous PTHrP
| Small cell: ACTH, SIADH
126
Acute calcium pyrophosphate crystal arthritis
Pseudogout
Acute inflam arthritis in the setting of surgery or illness
Synovial fluid: 15k-30k WBCs, rhomboid crystals
Chondrocalcinosis on Xray
127
Chrons disease
Skip lesions
Noncaseating granulomas
Transmural inflam, cobblestoning, creeping fat, linear ulcerations
Fistulas
128
Arrhythmia associated with digitalis toxicity
Atrial tachycardia with AV block
| Increased ectopy and increased vagal tone
129
Flow volume loop of a fixed upper airway obstruction
Flat on the top and bottom
130
Indications for urethrogram
Blood at the meatus
Hematuria
Dysuria
Urinary retention
131
First step after placing a central venous catheter
CXR for placement
132
Hard signs of vascular injury
Pulsatile bleeding
Bruits/thrills
Expanding hematoma
Distal ischemia
Needs urgent surgery
133
Treatment of Idiopathic Intracranial Hypertension
Acetazolamide +/- furosemide
| Weight loss
134
Joints of osteoarthritis v. Rheumatoid arthritis
OA- DIPs and PIPs
| RA- MCP
135
Post op from cardiac surgery: Fever, chest pain, leukocytosis with mediastinal widening on CXR
Mediastinitis
| drainage, surgical debridement, prolonged abx
136
Endocarditis plus 2:1 second degree AV block
Perivalvular abscess
137
Concern when there is a change in a burn wound or loss of a skin graft
Infection
Gram +
After 5 days: Gram -, fungi
138
Hypopituitarism
Low cortisol and ACTH (central adrenal insuff)
Low FSH and LH (hypogonadotropic hypogonadism)
Low T4 and low or normal TSH (central hypothyroid)
Aldosterone normal (may have mild hypoNa though)
139
Ventricular aneurysm
Months after MI
EKG: persistent ST elevations, deep Q waves
LV enlargement with dyskinetic wall motion-> heart failure
140
Polymalgia Rheumatica
```
50+
1+ mo pain in shoulder, hip, neck
Morning stiffness 1+ hour
ESR > 40
Constitutional ssx
Tx: low dose steroids
```
141
Concern after thyroidectomy
```
Hypoparathyroidism
Low Ca, high Phos
Fatigue, anxiety, depression
Tetany, seizures
QT prolongation
```
142
Fever + acute monoarticular arthritis
| First test
Synovial fluid analysis to rule out septic arthritis
| Risk factors: gout, osteoarthritis etc.
143
Watershed areas of the colon
Splenic flexure- SMA and IMA
| Rectosigmoid junction- Sigmoid a and superior rectal a
144
Where are dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) made?
Why would increased levels cause hirsuitism?
DHEA- ovaries and adrenals
DHEAS- adrenals
Converted to testosterone and androstenedione
145
Management of acute pain in a pt with hx of opioid abuse
Treat all acute patients the same despite hx (give morphine)
Close f/u to avoid relapse
146
Treatment of acute pancreatitis
```
Uncorrectable causes(ischemia/emboli): NPO, IVF
Necrotizing, local infection: abx also
```
147
Parkinsons + autonomic dysfunction
Multiple system atrophy
148
Dumping syndrome
Postgastrectomy complication
Nausea, diarrhea, cramps, palps, diaphoresis
Hypertonic stomach contents quickly dump into sm bowel
Eat small meals, slowly
Inc fiber and prot
149
Ludwig Angina
cellulitis of the submandibular space
Arise from dental infections- polymicrobial
elevated tongue, crepitus, mass effect from edema, watch the airway
CT, IV abx, remove tooth
150
Bronchial rupture
persistent pneumothorax despite chest tube, pneumomediastinum, subQ emphysema
CT, bronchoscopy, surgery
151
Effect of acetaminophen, NSAIDs, amiodarone and abx on warfarin
potentiates anticoag effects -> inc bleeding
152
Pt with fatigue, malaise, sore throat, fever, LAD, splenomeg, atypical lymphocytes with neg heterophile Ab test
EBV infectious mononucleosis
(25% false neg rate of heterophile test in the first week)
repeat test
153
Cat bite tx
Amoxicillin/clavulanate abx ppx
154
malabsorption, iron def anemia, villous atrophy
celiac disease
| IgA anti-tissue transglutaminase abs and anti-endosomal abs may be neg due to IgA deficiency
155
hypocalcemia, hyperphosphatemia with normal renal function
hypoparathyroidism
| -post surgery, autoimmune, non autoimm destruction, defective Ca sensors
156
How much does arterial/systolic pressure normally fall during inspiration?
<10mmhg
157
Pulsus paradoxus definition and causes
>10mmhg drop in systolic pressure during inspiration
pericardial effusion, asthma, COPD
158
Triad of fat embolism
respiratory distress, neuro dysfxn, petechial rash
159
Early post-op renal transplant dysfxn
Ureteral obstruction, acute rejection (IV steroids), cyclosporine toxicity, vascular obstruction, acute tubular necrosis
Radioisotope scanning, renal U/S, MRI, renal biopsy
160
A-a gradient in PE
Elevated due to VQ mismatch
| Cytokine induced bronchoconstriction
161
Salicylate intoxication
Fever, tinnitus, tachypnea
Mixed respiratory alkalosis and anion gap metabolic acidosis
Normal pH, low PaCO2, low HCO3
162
Gastric outlet obstruction
Postprandial pain, vomiting, early satiety
Abdominal succussion splash
Obstruction: malignancy, PUD, Crohns, strictures with pyloric stenosis, bezoars
163
Complications of MI
| Acute
Right RV failure
RCA
HypoTN, kussmal sign, clear lungs
164
Complications of MI
| Acute/ 3-5 days
Papillary Muscle rupture
-RCA, pulm edema, new holosytolic murmur
Intervent septum rupture
- LAD or RCA
- chest pain, new holosytolic murmur, bivent failure, shock, L to R shunting, inc O2 in RV
165
Complications of MI
| 5 days- 2 weeks
Free wall rupture
-LAD
chest pain, shock, distant heart sounds, pericardial eff/tamponade
166
Complications of MI
| Months
LV aneurysm
-LAD
Subacute heart failure, stable angina
167
Skin cancer on the lip
Squamous cell carcinoma
168
Unstable pt with penetrating trauma, FAST inconclusive
Ex lap
169
Unstable pt with blunt trauma, FAST inconclusive
Dx peritoneal lavage
| But actually ex lap
170
Aortoilliac occlusion
BL hip, thigh, butt claudication
Impotence
Absent/diminished femoral pulses
