UWorld Flashcards
Immunocompromised patient with macules and pustules that go on to become gangrenous ulcers, painless. Dx?
Ecythyma gangerenosum
Classic description of ecthyma gangerenosum
Lesions start out as macules, progress to bullae and vesicles then form punched out gangerenous ulcer, emperic abx treatment indicated
Questions about a woman with HAV and HBV disease living with boyfriend, what method will reduce transmission to her boyfriend
I said Hep B vaccine, the answer was Hep A vaccine since she recently acquired Hep A and it can also be transmitted sexually. The teaching point being people with hep A should have their close relatives get immunized
Expected dispstick finding of someone with pyelonephritis
Positive for nitrites (signifies Enterobaceteriea like E. Coli) and leukocyte esterase (signifies pyuria)
Upper abdominal masses in an asymptomatic man with HTN? What is the best next step
ADPKD, abdominal US
Retinal tears, grayish appearing retina and patient describing her symptoms as curtain coming down her eyes, had cateract surgery 4 months ago
Retinal detachment
Cut off time to give charcoal in acetaminophen toxicity?
4 hours
Does PE cause transudative or exudative pleural effusion?
Exudative, the only things that cause transudative are CHF, nephrotic syndrome and low albumin
What nerve malfunction causes ptosis?
CN III
What are pupil sparing and non pupil sparing CN III palsies?
Most common cause of non pupil sparing CN III palsy? Next best step?
Pupil sparing spare the parasympathetics that are on the outside, caused by both ischemia and compression, non pupil sparing affect both are usually caused by compression. Most common cause of compression by aneurysm, next best step is CT or MR angio
When to use defibrillator and when to use synchronized cardioversion?
Vifb and pulseless Vtach for defibrillator, afib, atrial flutter and Vtach with a pulse should be managed with synchronized cardioversion
CD4 counts for ppx of different infections
< 200 -> pneumocytis, <100 -> toxo, <50 -> mac ppx
First step to do when a male has sexual dysfunction
Next best step?
Check for primary or secondary hypogonadism, in primary testis fnx decrease so FSH and LH are high, in secondary FSH and LH levels are low, if secondary is suspected check prolactin levels
TNJ dysfunction treatment
Conservative first starting with night time teeth guard, surgery if all else fails, NO IMAGING required
Ramsay Hunt syndrome
Herpes zoster infection that causes Bell’s palsy, vesicles are seen in the outer ear
PCP like symptoms lasting for 4 days without syntagmus and unremarkable UDS?
Bath salts intoxication
What nephrotic syndromes are associated with what
FSGN - HIV and IV drug use
Membranous - Adenocarcinoma, NSAIDs, Hep B, SLE
Membranoproliferative - Hep B and C
Minimal change disease - lymphoma, NSAIDs
IgA nephropathy - URI
What nephrotic syndromes are associated with what
FSGN - HIV and IV drug use
Membranous - Adenocarcinoma, NSAIDs, Hep B, SLE
Membranoproliferative - Hep B and C
Minimal change disease - lymphoma, NSAIDs
IgA nephropathy - URI
Anti topoisomerase I antibodies
Systemic sclerosis, diffuse or generalized type
Anti cardiolipin antibodies
Antiphospholipid syndrome/disease
Anti cardiolipin antibodies
Anti phospholipid syndrome/disease
Fat embolism symptoms
Petechia, pulmonary infilterates and AMS
Breath held at certain inspiratory pressure, what does that pressure represent?
Pulmonary compliance
What is painless? HSV or CMV retinitis?
CMV
What is painless? HSV or CMV retinitis?
CMV
Describe CMV retinitis on fundoscopy
yellow-white, fluffy hemorrhagic lesions around the vasculature
Describe HSV retinitis
Ocular pain, tearing, discharge
What is so special about pleural effusions caused by RA
These are exudative in nature, most closely mimic bacterial pleural effusion as glucose is very low and LDH is very high
Hypothyroidism and prolactin levels
Hypothyroidism causes hyperprolactinemia
Hypothryroidism and prolactin levels
Hypothyroidism causes hyperprolactinemia
Do you see atypical lymphocytes in CMV mono infection?
Yes!
What establishes diagnosis if PR, dermatomyositis or polymyositis is suspected?
A muscle biopsy, I said ESR
Beta adranergics cause hypo or hyperkalemia?
HYPOKALEMIA, remember it by same as insulin
What are the 2 causes of hypoxemia that do not correct with supplemental O2
Intra pulmonary shunting like pneumonia and intracardiac shunting like ASD
There was a patient with weight loss, tachycardia, increased anxiety, thyroid toxic nodule, question was what is the best next therapy? RAU was WNL
Dx was painless thyroiditis, it is treated with propanolol. I said methimazole
Apparently only when RAU is increased diffusely then we use methimazole because that is when there is full blown hyperthyroidism
There was a patient with weight loss, tachycardia, increased anxiety, thyroid toxic nodule, palpitations, tremulousness, question was what is the best next therapy? RAI was WNL
Dx was painless thyroiditis, it is treated with propanolol. I said methimazole
Explain the following for interstitial lung disease:
TLC, FEV1/FVC, RC, DLCO, A-a gradient
TLC is decreased, FEV1/FVC increased, RC and DLCO decreased, A-a gradient increased
Explain the 4 big points of transplant associated complications
- During acute cellular rejection (< 90 days) like for example for liver transplant patients they will develop nausea, vomiting, RUQ pain, jaundice. HOWEVER they will not develop hemodynamic instability with hypotension and tachycardia. If there is hemodynamic instability consider BACTERIAL infection
Most common causes of infection in transplant pts: - Less than 1 month: always bacterial from operative or hospitalization causes
- Between 1 and 6 months: opportunistic infections like CMV, Mycobacterium TB, Toxo, Pneumocystic jirovecii etc
- More than 6 months: typical or most common infectious causes
7494
Hyperacute organ rejection timeline and cause?
Less than 1 week, antibody/complement mediated response such as ABO incompatibility
ED dysfunction due to cardiovascular disease tx?
Sildenafil, watch out if they are on nitroglycerin
trimethoprim electrolyte side effect?
Hyperkalemia
What disease involves dysfunction of inhibitory neurons?
Esophageal spasm
Pathology of scleroderma GI disorder
Smooth muscle atrophy and fibrosis
Cause of pulmonary HTN in scleroderma?
Arterial intimal hyperplasia
When is the only time when ambulatory BP monitoring is the answer
When there are signs of end organ damage due to HTN but patient presents to the clinic with normal BP. Had a question describing AV nicking and left ventricle hypertrophy but the pt BP was 130/80 so the answer was this. Patient often have high BP in these circumstance as evident by the fundoscopy and ECG finding but can present WNL BP at the clinic
What 2 disease of the GI tract can present similarly but one causes watery diarrhea and the other causes greasy diarrhea
Small intestinal bacterial overgrowth causes greasy diarrhea, lactose intolerance causes watery diarrhea, the rest of their symptoms are the same
Aplastic anemia pathogenesis and timing and what hematologic changes does it cause
Due to an acquired deficiency of pluripotent stem cells, can occur between 30 to 50 yo, causes pancytopenia
treatment of premature ventricular contractions?
Increase or add beta blocker
Blood tinged sputum coughing that last after a URI tx?
Nothing, probably from acute bronchitis, will clear up on its own
Most effective way of reducing potassium?
Insulin and glucose tx, cant do hemodialysis if they dont have a fistula ready
Lung pathology associated with ankylosing spondylitis
Restrictive pattern on PFT due to limited chest wall expansion
Treatment of postherpetic neuralgia
Gabapentin, pregabalin or TCAs, remember that there should be no rash
Classification of herpes zoster pain from shingles
Less than 30 days, treat with NSAIDs, analgesics - acute
More than 30 days, treat with NSAIDs, analgesics - subacute
More than 4 months, treat with gabapentin, pregabalin or TCAs
X ray findings of rheumatoid arthritis
Periarticular osteopenia with joint margin erosion, periarticular erosions
Hammer and claw toe deformity
Diabetic neuropathy in long standing diabetics, otherwise is normal people could be due to ill fitting shoes, look up what they look like
Lofgren syndrome
Tetrad of fever, erythema nodosum, hilar adenopathy and migratory polyarthralgia
Influenza tx?
Have to consider risk factors which are age > 65, chronic medical conditions, pregnancy. Those without risk factors can get anti virals if present within 48 hours, those WITH risk factors should get diagnostic testing and then treatment with oseltamivir and additionally anti viral if they present within 48 hours
What is peripartum cardiomyopathy and what is the next step
Cardiomyopathy during the last month of pregnancy or within 5 months following delivery, next step is to do ECHO to confirm and then treat like a heart failure patient. If there is hemodynamic instability then deliver
reflexes in hypo and hyperthyroidism
Brisk in hyper and sluggish in hypothyroidism
Pes Anserein syndrome and tx
Pain along the medial tibial condyle, no other finding. Its an overuse injury, tx is quadriceps strengthening and NSAIDs
Eosinophilic esophagitis presentation
Young, history of atopy like asthma, eczema etc, PPI refractory burning chest pain, episodes of food impaction due to stricture formation
Blood smear finding in autoimmune hemolytic anemia
Sperocytes, NOT Schistocytes (only seen in microangiopathic anemia)
Intrauterine growth restriction and NRDS
Decreases the chances of NRDS
What reference point do I use to help determine how spinothalamic tract ascends/descens
Sensation lost at umbilicus T10 and below has the lesion at T8 so it ascends
Treatment 3 points of anorexia nervosa
CBT, nutritional rehab and olanzapine if no response to the first 2
Metabolic abnormality associated with ankylosing spondylitis
Osteopenia and osteoporosis leading to fractures with minimal trauma
NEXT STEP when there is microcytic anemia with normal iron studies
Hb electrophoresis
