UWorld 8/10 Flashcards
0
Q
Acute lead exposure ssx?
A
- GI = abdominal pain, constipation
- Neurologic = headache, cognitive deficits, peripheral neuropathy
- Musculoskeletal = joint pains, muscle aches
- Hematologic = microcytic anemia w/ basophilic stippiling
- Anorexia
1
Q
Which antipsychotic has the least risk of TD?
A
-clozapine
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
3
Q
Most likely cause of microcytic anemia in kids?
A
-Pb poisoning
4
Q
Tx of lead poisoning?
A
-chelation
5
Q
What are 2 main things to look out for when tx with clozaril?
A
- Agranulocytosis
2. Seizures, it lowers the threshold
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
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)
8
Q
Imaging in dx of appedicitis?
A
- ONLY used when presentation is atypical and unclear
- normally this is a clinical dx!
9
Q
Ssx of digoxin tox?
A
- Cardiac = life-threatening arrhythmias
- GI = anorexia, nausea, vomiting, abdominal pain
- Neurologic = fatigue, confusion, wkness, visual disturbances (yellow halos)
* *think vangough starry night
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
11
Q
Dx procedure of choice when suspecting renal colic in pregnancy?
A
-abdominal US
12
Q
6 types of drugs that can cause acute pancreatitis?
A
- Diuretics = furosemide, thiazides
- Drugs for inflammatory bowel dz = sulfasalazine, 5-ASA
- Immunosuppressive agents = azathioprine
- HIV-related meds = didanosine, pentamidine
- Antibiotics = metronidazole, tetracycline
- Anti-seizure medications = valproic acid
13
Q
Low grade fever during first 24 hrs post-partum?
A
-common and normal
14
Q
Leukocytosis during the first 24 hrs postpartum?
A
-common and normal
15
Q
Intrapartum chills?
A
-common and normal
16
Q
Postpartum chills?
A
-common and normal
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!
18
Q
Best way to dx primary syphillis?
A
- with dark field microscopy
- serum tests have high false neg results in primary stage!
19
Q
Tx for epidural hematomas?
A
-emergency craniotomy!
20
Q
What type II DM meds can cause wt gain?
A
- sulfonylureas!
2. Thiazolidinediones
21
Q
What DM II meds can induce CHF in pts with heart dz?
A
-thiazolidinediones
22
Q
What DM II medication can help with weight loss?
A
-GLP-1 receptor agonists!
23
Q
Most common cause of acute liver failure in the US?
A
-acetaminophen toxicity
24
What are the three most common causes of severe acute hepatic injury? What is seen on labs?
- transaminase levels > 1000 U/L
1. Acute viral hepatitis
2. Ischemic hepatopathy ("shock liver")
3. Toxic liver injury (esp with acetaminophen)
25
Tx of acetaminophen intox?
-acetylcysteine to tx liver injury
26
What are the 3 most common cardiac abnormalities seen in turner's syndrome?
1. Bicuspid aortic valve
2. Coarctation of aorta
3. Aortic root dilation --> increased risk of aortic dissection
27
Triad for normal pressure hydrocephalus?
1. Gait disturbance
2. Dementia
3. Urinary incontinence
28
What is postcardiotomy syndrome?
- pericardial effusion that can occur days or months after cardiac surgery
- ssx:
1. Distant heart sounds
2. Hypotension
3. Distended jugular veins
29
Most common parasitic infection of the brain?
- neurocysticercosis caused by taenia solium (pork parasite)
- more common in a rural area with poorer sanitary conditions where pigs are raised
30
How is cystercosis contracted?
- by eating pork
| - but also can get even if dont eat pork!
31
Most common manifestations of cystercosis?
- multiple, small fluid-filled cysts in brain parenchyma (and can be found elsewhere in body, spread hematogenously)
- most commonly causes neurologic sx (seizures, etc)
32
What commonly causes an abrupt onset of nausea and vomiting?
-ingestion of preformed toxin or chemical irritants
33
What are the 2 most common causes of preformed toxin acutely induced vomiting in the US?
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)
34
Penile fracture?
- surgical emergency!
| - needs urgent urethral imaging (retrograde urethralgram) + surgical repair
35
Absent peristaltic waves in lower 2/3 of esophagus + decreased LES tone?
-Dismotility caused by scleroderma
36
What do you need to worry about after re-profusion?
-COMPARTMENT SYNDROME!
37
Embolic occlusion in a limb v compartment syndrome?
- BOTH cause: severe pain and paresthesias
- embolic occlusion causes: pulselessness, palor, an no local swelling
- compartment syndrome causes swelling and redness!!
38
Paralysis seen in botulism v tick borne dz?
- botulism = descending
| - tick = ascending
39
Rapidly ascending paralysis with one limb that is worse?
-think tick-borne paralysis!
40
Most common cause of unilateral cervical lymphadenitis in children? Best tx?
1. Strep
2. Staph
Tx: I&D + clindamycin (has good node penetration)
41
Cyclical vomiting: ssx? Cause? Tx?
- 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
How to dx PID as the cause of infertility?
-hysterosalpingogram
43
Abdominal pain that radiates to arms?
-highly suspicious for MI --> must rule this out first before doing a GI workup!
44
What condition is associated with bilateral trigeminal neuralgia?
-MS!
45
What drug is most commonly the cause of nephrogenic DI?
-lithium
46
Urine osmolality in DI?
-decreased = diluted
47
Urine [sodium] in DI?
-decreased = diluted
48
Serum osmolality in DI?
- increased
| - mainly consists of Na!
49
What can be seen on CXR with boerhaave syndrome?
1. Pneumomediastinum
2. Pleural effusions (usually left)
3. +/- pneumothorax
50
Pleural effusion fluid analysis in boreehave syndrome?
- Exudative
- low pH
- very HIGH amylase --> due to saliva in esophageal contents
51
Tests for pts with suspected BPH?
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
Sudden vasomotor collapse + skin rash?
- waterhouse-friderichsen syndrome
- adrenal hemorrhage
- due to fulminant meningococcemia infection
- has almost 100% mortality!
53
Specific mutation in marfans?
-fibrillin-1 gene
54
ESR in temporal arteritis?
- > 50
55
Hydatid disease: due to? How contracted? Ssx?
- 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
What is highly suggestive of a hydatid cyst?
-eggshell calcification of a hepatic cyst on CT scan!
57
Tx of hydatid cyst?
- DONT aspirate, bc spilling of content can cause anaphylaxis!
- tx = surgical resection + albendazole
58
Hip problem in infant?
-congenital hip dysplasia
59
Hip problem in ages 2-8 yrs old?
- Legg-Calve-Perthes disease
| - avscular necrosis of femoral head
60
Hip problem in adolescents?
-SCIFE
61
Skin cancer that arises from chronically wounded, scarred or inflamed skin?
- 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
First line tx for peripheral artery dz (4)?
- AKA claudication
1. Smoking cesation
2. Aspirin
3. Statin
4. Supervised exercise program
63
3 most common causes of chronic cough in non-smokers?
1. Post nasal drip
2. GERD
3. Asthma
64
When is prenatal antibody screening done? What does it test for? What to do for a negative result?
- 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
What is the most common inherited cause if hypercoagulability? What does it predispose the pt to?
- factor V leiden
| - predisposes to thromboses, esp DVT of lower extremities
66
Neonate w/ absent lung sounds on left, loud heart sounds on right, and decreased breath sounds on right? First step in management?
- congenital diaphragmatic hernia on the left (most common side)
- first: intubation
67
Opthalmoplegia, proptosis, severe eye pain, decreased visual acuity?
- orbital cellulitis!
| - opthalmologic emergency!!
68
What are 3 possible complications of orbital cellulitis?
1. Meningitis
2. Venous thromboses
3. Blindness
69
Most common congenital heart disease in Edward's syndrome?
-VSD
70
Micrognathia, microcephaly, rocker bottom feet, overlapping fingers, absent palmar creases?
-Edward's syndrome
71
Most common cause of urologic problem in kids? What does it increase the risk for?
- vesicoureteral reflux (VUR)
- risk factor for UTIs and pylenophritis
- recurrent UTIs can cause renal scarring
72
Best method for dx of VUR?
- voiding cystourethrogram (VCUG)
| - should be done in any child with recurrent febrile UTIs
73
OCPs and bp?
- can cause HTN
| - d/c the OCP to correct the problem
74
Cause of symmetric and circumferential narrowing of esophagus?
-peptic stricture --> commonly seen in GERD
75
Ssx of peptic stricture?
- dysphagia to solids, but no weight loss
| - in pts with hx of GERD
76
Leukemoid rxn: what is it? Dx?
- 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
How does the kidney compensate for resp alkalosis?
- by preferentially excreting biocarb in the urine
| - so urine will have HIGH pH (basic)
78
What can happen during the first few days of outpt tx with warfarin? Why?
- 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
Raloxifene: MOA? Use? Increased risk of?
- 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
Management for flail chest?
- pain control
| - supplemental oxygen
81
Arthritis in SLE?
- considered to be non-deforming
| - most commonly affects the hands
82
What nerve gives sensation to cornea?
-trigeminal nerve (V1)
83
What is chagas dz caused by? What 3 conditions can it cause?
- cause: trypanosoma cruzi (protazoan)
- causes:
1. Megaesophagus w/ achalasia
2. Megacolon
3. Cardiac dysfunction
* *seen in Latin America
84
Dark urine after taking TMP/SMX?
- G6PD deficiency
| - due to oxidative stress
85
Heinz bodies?
- seen in a hemolytic event in G6PD!
| - see bite cells too
86
Bite cells?
- seen in G6PD in a hemolytic event
| - see heinz bodies too
87
What is the normal compensation response for metabolic acidosis?
-tachypnea = increased CO2 loss
88
Most common cause of hypercalcemia in ambulatory setting?
- hyperparathyroidism!
| - so test PTH first!
89
Lots of puss filled skin infections and abscesses?
-think chronic granulomatous disease!
90
Tx for hemodynamically stable supraventricular tachy?
-vagal maneuvers + adenosine and AV nodal blockers
91
Tx for hemodynamically unstable pts with supraventricular tachycardia?
-DC cardioversion
92
What to test for with new onset a-fib?
- occult hyperTH
| - get TSH and free T4
93
Most common organism that causes osteomyelitis?
-staph aureus
94
Best tx of pain in a pt with past opioid addiction?
- IV morphine --> faster onset of action than oral meds
| - make sure to tx pain regardless of past addictioncs!
95
What is the idea behind the effect of standing on murmurs?
- they decrease venous return to the heart
| - usually decrease the intensity of the murmur
96
What is the idea behind the effect of the valsalva manuver on murmurs?
- it decreases venous return to the heart
| - usually decreases the intensity of the murmur
97
What is a common site of osteomyelitis in Iv drug users?
-the spine
98
2 Groups at highest risk for osteomyelitis?
1. Sickle cell anemia pts
| 2. IV drug users
99
What is the most reliable ssx of vertebral osteomyelitis?
-tenderness with gentle percussion over the spinous process
