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Step 2 UWorld > UWorld 8/10 > Flashcards

UWorld 8/10 Flashcards

0
Q

Acute lead exposure ssx?

A
  1. GI = abdominal pain, constipation
  2. Neurologic = headache, cognitive deficits, peripheral neuropathy
  3. Musculoskeletal = joint pains, muscle aches
  4. Hematologic = microcytic anemia w/ basophilic stippiling
  5. Anorexia
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1
Q

Which antipsychotic has the least risk of TD?

A

-clozapine

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2
Q

Chronic lead exposure ssx?

A
  • *ssx of acute exposure (neurologic, GI, anemia, musculoskeletal, and anemia) plus:
    1. Nonspecific ssx = fatigue, insomnia
    2. HTN
    3. Neuropsych ssx
    4. Nephropathy (^^creatinine)
    5. Reproductive effects = miscarriages, stillbirths
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3
Q

Most likely cause of microcytic anemia in kids?

A

-Pb poisoning

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4
Q

Tx of lead poisoning?

A

-chelation

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5
Q

What are 2 main things to look out for when tx with clozaril?

A
  1. Agranulocytosis

2. Seizures, it lowers the threshold

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6
Q

How is Parkinson’s dz dx?

A
  • via PE
  • 2/3 cardinal ssx must be present:
    1. Resting tremor
    2. Rigidity
    3. Bradykinesia
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7
Q

How is appendicitis dx?

A
  • via physical ssx + labs

- only if clinical picture is not typical is imaging required (either CT or ultrasound)

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8
Q

Imaging in dx of appedicitis?

A
  • ONLY used when presentation is atypical and unclear

- normally this is a clinical dx!

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9
Q

Ssx of digoxin tox?

A
  1. Cardiac = life-threatening arrhythmias
  2. GI = anorexia, nausea, vomiting, abdominal pain
  3. Neurologic = fatigue, confusion, wkness, visual disturbances (yellow halos)
    * *think vangough starry night
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10
Q

The addition of which medication can increase digoxin levels ?

A

-amioderone –> so decrease digoxin dose by 25-50% and then. He k the dig level weekly

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11
Q

Dx procedure of choice when suspecting renal colic in pregnancy?

A

-abdominal US

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12
Q

6 types of drugs that can cause acute pancreatitis?

A
  1. Diuretics = furosemide, thiazides
  2. Drugs for inflammatory bowel dz = sulfasalazine, 5-ASA
  3. Immunosuppressive agents = azathioprine
  4. HIV-related meds = didanosine, pentamidine
  5. Antibiotics = metronidazole, tetracycline
  6. Anti-seizure medications = valproic acid
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13
Q

Low grade fever during first 24 hrs post-partum?

A

-common and normal

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14
Q

Leukocytosis during the first 24 hrs postpartum?

A

-common and normal

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15
Q

Intrapartum chills?

A

-common and normal

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16
Q

Postpartum chills?

A

-common and normal

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17
Q

Lochia? Changes?

A
  • discharge postpartum
  • lochia rubia (red) for first few days –> lochia serosa (pale) after 3/4 days –> lochia alba (yellow/white)
  • if foul smelling –> suspect endometritis!
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18
Q

Best way to dx primary syphillis?

A
  • with dark field microscopy

- serum tests have high false neg results in primary stage!

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19
Q

Tx for epidural hematomas?

A

-emergency craniotomy!

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20
Q

What type II DM meds can cause wt gain?

A
  1. sulfonylureas!

2. Thiazolidinediones

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21
Q

What DM II meds can induce CHF in pts with heart dz?

A

-thiazolidinediones

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22
Q

What DM II medication can help with weight loss?

A

-GLP-1 receptor agonists!

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23
Q

Most common cause of acute liver failure in the US?

A

-acetaminophen toxicity

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24
Q

What are the three most common causes of severe acute hepatic injury? What is seen on labs?

A
  • transaminase levels > 1000 U/L
    1. Acute viral hepatitis
    2. Ischemic hepatopathy (“shock liver”)
    3. Toxic liver injury (esp with acetaminophen)
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25
Q

Tx of acetaminophen intox?

A

-acetylcysteine to tx liver injury

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26
Q

What are the 3 most common cardiac abnormalities seen in turner’s syndrome?

A
  1. Bicuspid aortic valve
  2. Coarctation of aorta
  3. Aortic root dilation –> increased risk of aortic dissection
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27
Q

Triad for normal pressure hydrocephalus?

A
  1. Gait disturbance
  2. Dementia
  3. Urinary incontinence
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28
Q

What is postcardiotomy syndrome?

A
  • pericardial effusion that can occur days or months after cardiac surgery
  • ssx:
    1. Distant heart sounds
    2. Hypotension
    3. Distended jugular veins
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29
Q

Most common parasitic infection of the brain?

A
  • neurocysticercosis caused by taenia solium (pork parasite)
  • more common in a rural area with poorer sanitary conditions where pigs are raised
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30
Q

How is cystercosis contracted?

A
  • by eating pork

- but also can get even if dont eat pork!

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31
Q

Most common manifestations of cystercosis?

A
  • multiple, small fluid-filled cysts in brain parenchyma (and can be found elsewhere in body, spread hematogenously)
  • most commonly causes neurologic sx (seizures, etc)
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32
Q

What commonly causes an abrupt onset of nausea and vomiting?

A

-ingestion of preformed toxin or chemical irritants

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33
Q

What are the 2 most common causes of preformed toxin acutely induced vomiting in the US?

A
  1. Staph aureus –> poultry and egg products (esp mayo), meat and meat products, milk and dairy products (cream filled paistries)
  2. Bacillus cerus (heat stable exotoxin) –> starchy foods (classically, reheated fried rice)
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34
Q

Penile fracture?

A
  • surgical emergency!

- needs urgent urethral imaging (retrograde urethralgram) + surgical repair

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35
Q

Absent peristaltic waves in lower 2/3 of esophagus + decreased LES tone?

A

-Dismotility caused by scleroderma

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36
Q

What do you need to worry about after re-profusion?

A

-COMPARTMENT SYNDROME!

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37
Q

Embolic occlusion in a limb v compartment syndrome?

A
  • BOTH cause: severe pain and paresthesias
  • embolic occlusion causes: pulselessness, palor, an no local swelling
  • compartment syndrome causes swelling and redness!!
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38
Q

Paralysis seen in botulism v tick borne dz?

A
  • botulism = descending

- tick = ascending

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39
Q

Rapidly ascending paralysis with one limb that is worse?

A

-think tick-borne paralysis!

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40
Q

Most common cause of unilateral cervical lymphadenitis in children? Best tx?

A
  1. Strep
  2. Staph
    Tx: I&D + clindamycin (has good node penetration)
41
Q

Cyclical vomiting: ssx? Cause? Tx?

A
  • ssx: recurrent, self limiting episodes of nausea and vomiting, with no apparent cause
  • cause: unknown, common in kids who have parents with migraines
  • tx: anti-emetics + reassurance
42
Q

How to dx PID as the cause of infertility?

A

-hysterosalpingogram

43
Q

Abdominal pain that radiates to arms?

A

-highly suspicious for MI –> must rule this out first before doing a GI workup!

44
Q

What condition is associated with bilateral trigeminal neuralgia?

A

-MS!

45
Q

What drug is most commonly the cause of nephrogenic DI?

A

-lithium

46
Q

Urine osmolality in DI?

A

-decreased = diluted

47
Q

Urine [sodium] in DI?

A

-decreased = diluted

48
Q

Serum osmolality in DI?

A
  • increased

- mainly consists of Na!

49
Q

What can be seen on CXR with boerhaave syndrome?

A
  1. Pneumomediastinum
  2. Pleural effusions (usually left)
  3. +/- pneumothorax
50
Q

Pleural effusion fluid analysis in boreehave syndrome?

A
  • Exudative
  • low pH
  • very HIGH amylase –> due to saliva in esophageal contents
51
Q

Tests for pts with suspected BPH?

A
  1. Urinalysis –> look for hematuria (stones or bladder ca) or infection
  2. Creatinine –> to look for obstruction
    - if either are abnormal, do an abdominal US
    * *after rectal exam confirms suspicion!
52
Q

Sudden vasomotor collapse + skin rash?

A
  • waterhouse-friderichsen syndrome
  • adrenal hemorrhage
  • due to fulminant meningococcemia infection
  • has almost 100% mortality!
53
Q

Specific mutation in marfans?

A

-fibrillin-1 gene

54
Q

ESR in temporal arteritis?

A
  • > 50
55
Q

Hydatid disease: due to? How contracted? Ssx?

A
  • Due to ecchinococcus granulosus infection
  • humans get it from close intimate contact with dogs (dogs are definitive hosts)
  • causes unilocular cystic lesions in any organ (liver, lungs, muscle, & bones) –> usually asymptomatic and found incidentally, but can cause sx from compression of local tissue
56
Q

What is highly suggestive of a hydatid cyst?

A

-eggshell calcification of a hepatic cyst on CT scan!

57
Q

Tx of hydatid cyst?

A
  • DONT aspirate, bc spilling of content can cause anaphylaxis!
  • tx = surgical resection + albendazole
58
Q

Hip problem in infant?

A

-congenital hip dysplasia

59
Q

Hip problem in ages 2-8 yrs old?

A
  • Legg-Calve-Perthes disease

- avscular necrosis of femoral head

60
Q

Hip problem in adolescents?

A

-SCIFE

61
Q

Skin cancer that arises from chronically wounded, scarred or inflamed skin?

A
  • Marjolin ulcer = squamous cell carcinoma
  • commonly occurs over site of osteomyelitis, radiotx scars, or venous ulcers
  • tend to be more aggressive –> early dx is important to prevent maets
62
Q

First line tx for peripheral artery dz (4)?

A
  • AKA claudication
    1. Smoking cesation
    2. Aspirin
    3. Statin
    4. Supervised exercise program
63
Q

3 most common causes of chronic cough in non-smokers?

A
  1. Post nasal drip
  2. GERD
  3. Asthma
64
Q

When is prenatal antibody screening done? What does it test for? What to do for a negative result?

A
  • done at initial prenatal visit
  • tests to see if the mother has anti-Rh antibodies
  • if negative: give anti-D Rh immunoglobulins at 28wks-35 wks gestation bc the mother does not yet have antibodies, want to keep it that way! (The immunoglobulins have a half-life of about 6 wks, thats why you give them then)
  • also give the immunoglobulins again w/in 72 hrs of the delivery if the baby is found to be Rh positive!!
65
Q

What is the most common inherited cause if hypercoagulability? What does it predispose the pt to?

A
  • factor V leiden

- predisposes to thromboses, esp DVT of lower extremities

66
Q

Neonate w/ absent lung sounds on left, loud heart sounds on right, and decreased breath sounds on right? First step in management?

A
  • congenital diaphragmatic hernia on the left (most common side)
  • first: intubation
67
Q

Opthalmoplegia, proptosis, severe eye pain, decreased visual acuity?

A
  • orbital cellulitis!

- opthalmologic emergency!!

68
Q

What are 3 possible complications of orbital cellulitis?

A
  1. Meningitis
  2. Venous thromboses
  3. Blindness
69
Q

Most common congenital heart disease in Edward’s syndrome?

A

-VSD

70
Q

Micrognathia, microcephaly, rocker bottom feet, overlapping fingers, absent palmar creases?

A

-Edward’s syndrome

71
Q

Most common cause of urologic problem in kids? What does it increase the risk for?

A
  • vesicoureteral reflux (VUR)
  • risk factor for UTIs and pylenophritis
  • recurrent UTIs can cause renal scarring
72
Q

Best method for dx of VUR?

A
  • voiding cystourethrogram (VCUG)

- should be done in any child with recurrent febrile UTIs

73
Q

OCPs and bp?

A
  • can cause HTN

- d/c the OCP to correct the problem

74
Q

Cause of symmetric and circumferential narrowing of esophagus?

A

-peptic stricture –> commonly seen in GERD

75
Q

Ssx of peptic stricture?

A
  • dysphagia to solids, but no weight loss

- in pts with hx of GERD

76
Q

Leukemoid rxn: what is it? Dx?

A
  • marked increase in WBCs in response to an infection or inflammation
  • can look like CML on peripheral blood smear, BUT leukemoid rxn will have an increased leukocyte alkaline phosphatase (LAP) score
  • LAP is usually low in CML
77
Q

How does the kidney compensate for resp alkalosis?

A
  • by preferentially excreting biocarb in the urine

- so urine will have HIGH pH (basic)

78
Q

What can happen during the first few days of outpt tx with warfarin? Why?

A
  • can have protein C deficiency bc it has a shorter half life than the clotting factors inhibited
  • so the pt is actually in a hypercoagulable state and at risk for thrombus formation and skin necrosis (esp if pt has underlying congenital protein C def)
79
Q

Raloxifene: MOA? Use? Increased risk of?

A
  • MOA: antagonizes estrogen in breast and vaginal tissue & agonist of estrogen in bones
  • use: first-line agent for prevention of osteoporosis (can also decrease breast CA risk)
  • risk: thromboembolism
80
Q

Management for flail chest?

A
  • pain control

- supplemental oxygen

81
Q

Arthritis in SLE?

A
  • considered to be non-deforming

- most commonly affects the hands

82
Q

What nerve gives sensation to cornea?

A

-trigeminal nerve (V1)

83
Q

What is chagas dz caused by? What 3 conditions can it cause?

A
  • cause: trypanosoma cruzi (protazoan)
  • causes:
    1. Megaesophagus w/ achalasia
    2. Megacolon
    3. Cardiac dysfunction
  • *seen in Latin America
84
Q

Dark urine after taking TMP/SMX?

A
  • G6PD deficiency

- due to oxidative stress

85
Q

Heinz bodies?

A
  • seen in a hemolytic event in G6PD!

- see bite cells too

86
Q

Bite cells?

A
  • seen in G6PD in a hemolytic event

- see heinz bodies too

87
Q

What is the normal compensation response for metabolic acidosis?

A

-tachypnea = increased CO2 loss

88
Q

Most common cause of hypercalcemia in ambulatory setting?

A
  • hyperparathyroidism!

- so test PTH first!

89
Q

Lots of puss filled skin infections and abscesses?

A

-think chronic granulomatous disease!

90
Q

Tx for hemodynamically stable supraventricular tachy?

A

-vagal maneuvers + adenosine and AV nodal blockers

91
Q

Tx for hemodynamically unstable pts with supraventricular tachycardia?

A

-DC cardioversion

92
Q

What to test for with new onset a-fib?

A
  • occult hyperTH

- get TSH and free T4

93
Q

Most common organism that causes osteomyelitis?

A

-staph aureus

94
Q

Best tx of pain in a pt with past opioid addiction?

A
  • IV morphine –> faster onset of action than oral meds

- make sure to tx pain regardless of past addictioncs!

95
Q

What is the idea behind the effect of standing on murmurs?

A
  • they decrease venous return to the heart

- usually decrease the intensity of the murmur

96
Q

What is the idea behind the effect of the valsalva manuver on murmurs?

A
  • it decreases venous return to the heart

- usually decreases the intensity of the murmur

97
Q

What is a common site of osteomyelitis in Iv drug users?

A

-the spine

98
Q

2 Groups at highest risk for osteomyelitis?

A
  1. Sickle cell anemia pts

2. IV drug users

99
Q

What is the most reliable ssx of vertebral osteomyelitis?

A

-tenderness with gentle percussion over the spinous process

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