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Uworld questions > uworld 8 > Flashcards

uworld 8 Flashcards

1
Q

how does svr macrocytifc anemia px?

A

dyspnea, fatigue, generalized weakness, can occur w/ chronic hemolysis

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2
Q

How does splenic sequestriation px w/ sickle cell disease?

A

sudden and rapid fall in Hgb

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3
Q

How does BPH px?

A

incrsd fequency, hesitancy, dribbling, nocturia, enlarged smooth prostate

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4
Q

What is pathogen of HIT type 2?

A

heparin binding to platelet factor 4, IgG ab binds to complex leading to platelet activation and consumption + incrsd risk thrombosis

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5
Q

Si/sx of amyotrophic lateral sclerosis?

A

get upper and LMN lesions, get atrophy bulbar signs, muscle weakness (distal > prox), hyperreflexia, spsasticity, fasciculations

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6
Q

CV risk w/ marfan sydnrome?

A

incrsd risk of aortic dilation, regurg, dissection, MVP.

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7
Q

What is an orthostatic proteinuria test?

A

obtain daytime (upright) and nighttime (supine) urine collections for protein quantificiation

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8
Q

What drugs most notorious for tubulointerstitial nephritis?

A

beta lactam ABX

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9
Q

How w/u persistent isolated hematuria?

A

Needs cystoscopy to ID cause, will likely also require kidney U/S

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10
Q

What suggests nonglomerular hematuria?

A

if RBCs of nml morphology on UA w no RBC casts or proteinuria

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11
Q

Risk fx for GU cancers?

A

smoking, male, >50 y/o, exposure to benzene, radiation, cyclophosphamide

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12
Q

How does ETOH cause rhabdo?

A

causes hypophosphatemia leading to muscle wasting

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13
Q

How would bladder outlet obstrxn px?

A

type men w/ difficulties w/ flow, px w/ poor UOP, suprapubic pain, hydronephrosis on kidney U/S

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14
Q

Si/sx of prerenal azotemia?

A

hypotension, hypoNa, dcrsd Urinary Na, bland urinary sediment.

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15
Q

How does tumor lysis px? How manage?

A

hyperuricemia, hyperphosphatemia, hyperkalemia. Give allopurinol or rasburicase

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16
Q

What is critical management in pt w/ CKD?

A

most closely mange bp, target <125/75

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17
Q

When is dialysis indicated?

A

Uncontrolled hyperK, refract hypervolemia, or AMS, uremic pericarditis, bleeding due to uremic platelets.

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18
Q

Which is better kidney xplant or dialysis?

A

Best to attempt kidney transplant.

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19
Q

How long does it take to get DM nephropathy?

A

usually 5-10 yrs of uncontrolled DM, also commonly occurs w/ diabetic retinopathy

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20
Q

Result of CKD on calcium homeostasis?

A

get incrs in phosphorous and dcrs in 1,25 vit D — > dcrs in Ca and incrs in PTH

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21
Q

How calculate urine anion gap?

A

(Ur Na + Ur K) - Ur Cl. Nml is 30-50

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22
Q

If abnml UAG?

A

if lrge, neg UAG then likely metabolic acidosis of extrarenal origin w.out gap

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23
Q

What is expected relation btwn PCO2 and bicarb?

A

For each 1 meq incrs in bicarb, should have 0.7 mmHg incrs in PCO2. BIcarb will incrs by 1 meq for each 10 mmhg incrs in PCO2

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24
Q

What is eqtn for plasma osmolality?

A

2(Na) + (BUN/2.8) + (Gluc/18)

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25
Q

ECG signs of hyperK?

A

spiked T waves & widened QRS

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26
Q

What is affect of villous adenoma on lytes?

A

causes hypokalemia

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27
Q

What is acute pancreatitis affect on Ca?

A

Dcrsd serum Ca due to chelation w/ FFA released by panc enzymes that get into peritoneum due to panc necrosis

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28
Q

How tx hypercalcemia 2/2 sarcoidosis?

A

Incrs serum Ca due to incrsd prodxn of 1a hydroxylase by macroph. — Incrsd 1,25 vit D. tx w/ corticosteroids

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29
Q

What is cinacalcet and when used?

A

parathyroid Ca sensing receptor blocker. Used in secondary hyperPTH

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30
Q

What are nml phosphorous levels?

A

2.5-4.5 mg/dl

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31
Q

What is issue w/ phosphorous in chronic alcoholic?

A

once receive tx (insulin + gluc), phos shifts into cells exposing deficit in body stores

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32
Q

How does hypophosphatemia px?

A

If acute — confusion, rhabdo, hemolytic anemia, svr muscle weakness

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33
Q

How does trousseau’s syndrome present?

A

Migratory superficial thrombophletbitis — single or multiple tender, erythematous and palpable cord like veins.

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34
Q

If develop troussea’s?

A

Should begin work up to determine if visceral tumor present

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35
Q

Cause of Meniere’s disease?

A

Due to distention of endolymphatic compartment of inner ear. Triggered by ETOH, caffeine, nicotine, salt. Managed initially w/ salt restriction.

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36
Q

How meniere’s disease px?

A

vertigo x 20 min/ episode, hearing loss, tinnitus. May have postural instability/ vomiting w/ nystagmus

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37
Q

What is hypertrophic osteoarthropathy?

A

digital clubbing occurs w/ sudden onset arthropathy esp in wrist and hand joints. Can be assoc w/ lung cancer, TB, bronchiectasis, emphysema.

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38
Q

Who likely to get diarrhea due to shigella?

A

DAy care centers and other institutions.

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39
Q

Likely cause of yersinia enterocolitica?

A

eating undercooked pork

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40
Q

Most common cause of campylobacter infxn? How px?

A

eating undercooked poultry, px w/ watery/bloody diarrhea + svr ab pain.

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41
Q

Findings w/ OA?

A

involves DIP more than PIP, MCP — px w/ shortening joint space, osteophytes

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42
Q

CAuse and px of foot drop?

A

2/2 trauma to common peroneal n. or radiculopathy to nay of spinal roots (L4-S2), px w. steppage gate (high stepping w/ exaggerated flex of hip + knee since cannot dorsiflex foot)

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43
Q

What are indications for lipid lowering tx?

A

If hx of ACS/MI, angina, past revasc, PAD — do statin tx. If LDL>/= 190 — statin tx, if 40-75 y.o w/ dm then likely need statin.

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44
Q

How manage PAD?

A
  1. if intermittent claudication, start w/ graded exercise program. Reduce other CV risk fx (dm, htn).
  2. DO antiplatelet to dcrs risk of MI, stroke, etc.
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45
Q

What is common side effect w. Ca channel blockers?

A

can get peripheral edema — due to peripheral vasodilation.

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46
Q

How manage asx, mild hyperCa (<12)

A

avoid thiazides and lithium.

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47
Q

How manage moderate hyperCa (>14) or sx hyperCa

A

short tx w/ NS + calcitonin, avoid loops unless volume overloaded. Long term tx w. zolendronate

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48
Q

Mechanism of nitrates as tx for angina?

A

Vasodilate capacitance vessels (veins), dcrs preload leading to dcrs contraction of ventricles and dcrs myocardial ox demand.

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49
Q

CAuse of progressive multifocal leukoencephalopathy?

A

Due to reactivation of JC virus in AIDS pts

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50
Q

Px of PML in AIDS pts?

A

involvement of cortical white matter, gradual onset of sx w. hemiparesis, speech, vision, gout probs, non-enhancing demyelin lesions on MRI

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51
Q

CSF findings w/ GBS? How tx?

A

high protein w/ no other abnormalities. Tx w/ supportive care, IVIG, plasmapharesis

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52
Q

How does rotator cuff impingement px?

A

pain during reaching or lifting arm above head, usualyl due to repetitive movement. Confirm w/ Neers test

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53
Q

How does adhesive capsulitis px?

A

similar px as rotator cuff tendinitis except pain will not relent w/ lidocaine injxn.

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54
Q

When do CEA?

A

If asx, obstrxn >70%, good 5 year survivaal, and accessible stenosis site. Aspirin only prevents further wrosening, once significant blockage, aspirin has no benefit.

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55
Q

How remove tick?

A

with tweezers, grab as close to skin as possible and pull away

56
Q

Px of dense membranoproliferative GMN?

A

dense depostis of C3 in GBM. nephrotic proteinuria, hematuria.

57
Q

What is pathophys of MPGN?

A

IgG against C3 convertase leads to persistent activation of alt. complement pathway.

58
Q

What disease due to anti-GBM ab?

A

goodpastures disease

59
Q

How does seborrheic dermatitis px?

A

fine, loose, yellow greasy looking scales. May be due to pitryosporum.

60
Q

What is seborrheic dermatitis suggestive of?

A

If multiple present, suggestive of GI tract cancer

61
Q

How tx simple metastatic brain mass?

A

if possible, surgically resect then whole brain radiation.

62
Q

What is differential for elevated serum protein?

A

multiple myeloma, MGUS, waldenstrom’s, amyloidosis

63
Q

How w/u MGUS?

A

Do metastatic bone surgey (xray of long bones and skull) to r/o lytic lesions.

64
Q

How dx amyloidosis?

A

abd fat pad biopsy

65
Q

What is serious risk w/ PTU tx for hyperT?

A

can induce agranulocytosis, usually px w/ fvr and sore throat.

66
Q

How manage prolactinoma?

A

if 10mm, tx w/ surgery.

67
Q

How tx ethylene glycol or methanol poisoning?

A

Use inhibition of alcohol dehydrog w/ either ethanol or fomepizide

68
Q

Signs of diabetic autonomic neuropathy?

A

Dcrsd appetite, nausea, ab pain, occ vomiting 2/2 delayed gastric emptying/ gastroparesis, can cause hypoglycemic episodes.

69
Q

How manage gastroparesis in diabetics?

A

rec small freq meals and incrsd fiber intake. Give metoclopramide for incrsd gastric emptying.

70
Q

How does ETOH hepatitis appear on biopsy?

A

mallory bodies, neutrophil infiltirate, liver cell necrosis and perivenular distrib of inflamm.

71
Q

When necessary to send aspirated fluid of breast cyst for cytology?

A

If fluid is bloody or foul.

72
Q

How does fibrocystic disease of breast px?

A

firm, movable, rubbey mass w/ clear fluid w/ aspiration, cyst disappears following aspiration.

73
Q

Common side effects of aminoglycosides

A

Ototoxicity px w/ vertigo, gait imbalance, hearing loss, esp w/ gentamicin, due to damage to inner ear hair cells, nephrotoxicity.

74
Q

How screen for MEN syndrome? Prophylactic if positive?

A

do DNA test of pt and family. If MEN2A or B, do total thyroidectomy.

75
Q

How does babesiosis px?

A

endemic in NE US, px w/ hemolysis, haundice, hemoglobinuria, renal failure, death. fvr, drenching sweats, malaise

76
Q

How dx and tx babesiosis?

A

Do giemsa stain of periph smear, tx w/ quinine-clinda or atovaquone + azithromycin

77
Q

What is px of erhlichiosis?

A

rockey mounted spotted fever

78
Q

Si/sx of hyperthyroidism?

A

anxiety, insomnia, palpitations, heat intol, incrsd sweating, weight loss, goiter, htn, tremors, hyperreflex, prox muscle weakness

79
Q

What are criteria for CHAD score?

A

Age>/=75, htn, DM, CHF each 1 pnt. Prior stroke = 2 pts,

80
Q

What do diff levels of scores on CHAD score mean?

A

if 0 pts, just do aspirin, if >2 need warfarin or dabigatran, if 1-2 then consider clinical situation in choosing anticoag tx.

81
Q

Common s/e of amiodarone?

A

CV - brady/ heart block, pulm - chronic interstitial pneumonitis, hypo/hyperthyroid, incrsd LFTs, hepatitis, optic neuropathy, blue-gray skin, periph neurop

82
Q

How does digoxin toxicity px?

A

N/V/D anorexia, confusion, arrhythm, vision probs

83
Q

How manage RA?

A

begin w/ DMARDS (methotrexate), can do cox 2 inhibt for sx tx, if sx persists add 2nd non-biologic (hydroxychloro or sulfasalazine), if persists do etanercept.

84
Q

How w/u 1st episode of unprovoked seizure?

A

if self limited no post-seizure benzo/phenytoin ppx needed. Do CT or MRI to determine any underlying probs.

85
Q

How does giardiasis px?

A

fatty, foul smelling stools, bloating, flatulence, N, malaise, ab cramps

86
Q

How dx histoplasmosis quickly?

A

Urine or serum ANTIGEN, not antibody

87
Q

How tx histo dissem infxn in HIV pts?

A

Use IV ampho x 2 wks, then itraconazole if svr, or just itracon if mild-mod

88
Q

What does presence of PAD indicate?

A

significant risk fx for MI in 5 years

89
Q

If bilirubin is in urine what does that indicate?

A

means signif amt of conjugated bili (unconj not water soluble)

90
Q

What is rotor syndrome?

A

benign disease w/ defect in hepatic storage— incr in conj bilirubin w/ jaundice, nml LFTs

91
Q

What is effect of DM on kidneys?

A

first get glomerular hyperperfusion, renal hypertrophy, incrs in GFR. Then get GBM thickening, glomerular hypertrophy, mesangial volume expansion next.

92
Q

What is effect of htn on kidneys?

A

hypertrophy, intimal fibrosis of arterioles, glomerular and peritubular fibrosis

93
Q

If lasting diarrheal illness after travel, think what?

A

More likely parasatic if > 1 week, bacterial infxns usually short and self limiting.

94
Q

How does cryptosporidium px?

A

lasting high volume watery diarrhea, w/out blood.

95
Q

How does enteamoeba GI infxn px?

A

following travel to SE Asia, Africa, L.A., get abd pain and bloody diarrhea

96
Q

How tx signif pain in recovered opioid abuser?

A

still need IV morphine like anyone else. Undertreatment equally signif risk fx for relapse.

97
Q

How prevent gout attacks in leukemic tx?

A

allopurinol or other xanthine oxidase inhibitors

98
Q

How manage symptomatic bradycardia?

A

1st attempt to correct w/ atropine. IF fails do xcutaneous pacing.

99
Q

DDX of restrictive lung disease?

A
  1. interstitial lung diseae. 2. neuromusc dx. 3. alveolar edema. 4. pleural fibrosis 5. chest wall abnormalities.
100
Q

Young patient w/ low back pain and restrictive lung disease?

A

think ankylosing spondylitis, have incrsd FRC due to chest wall motion restriction.

101
Q

What can cause a dcrsd DLCO?

A

interstitial edema, interstitial infiltrate, tissue fibrosis, COPD/emphysema.

102
Q

Best test to dx asthma?

A

can do methacholine challenge which induces bronchoconstrxn

103
Q

How use methacholine challenge?

A

get provacative concentration leading to dcrs of 20% of FEV1. If dose less than 4 mg/ml then positive test for asthma.

104
Q

How differentiate neuromuscular cause of lung disease?

A

NM disease causes restrictive pattern on PFTs w/ incrsd RV/TLC ratio. Incrsd RV/TLC ratio typically seen in obstructive pattern.

105
Q

What is hepatopulmonary syndrome?

A

dyspnea @ rest, platypnea, hypoxemia in setting of chronic liver diseae. Also have clubbing, cyanosis, hypoxemia.

106
Q

What is platypnea?

A

Worsening dyspnea when sitting up.

107
Q

WHat is pathophys in hepatopulm syndrome?

A

get pulm vascular dilatation w/ intrapulmonary shunting & VQ mismathc.

108
Q

How does vocal cord dysfxn present?

A

throat and neck discomfort, wheezing, stridor, not corrected w/ beta agonist. Dx w/ laryngoscopy - see adduction of cords.

109
Q

Possible pulmonary manifestations of Systemic sclerosis (CREST)

A

can get pulmonary artery htn or interstitial lung disease.

110
Q

Px of PAH in pt w/ CREST?

A

worsening fatigue + dyspnea on exertion w/ clear lung fields and nml cxr.

111
Q

Indications for chest tube placement?

A

effusion w/ ph1000, + gram stain, cx or presence of pus

112
Q

How differentiate effusion or lobar pneumonia?

A

effusion px w/ dcrsd breath sounds, dcrsd fremitus, dullness. Lobar pneumo px w/ bronchial breath sounds, icnrsd fremitus,

113
Q

How dx chylothorax?

A

pleural fluid TG> 110 typically.

114
Q

Cause of acute resp failure in setting of asthma?

A

incrsd airway resistance leading to dynamic hyperinflation that reduces chest wall complaince.

115
Q

If poor responding acute asthma exacerbation, how manage if on albuteral, inhaled steroids?

A

D o short 5-7 day course of PO roids, if steroids not possible, do leukotriene.

116
Q

How manage persistent asthma w. steroid/ albuterol?

A

If not respond to inhaled steroid/ albuterol, do long term beta agonist next, if this fails add leukotriene modifier

117
Q

How manage major COPD exacerbation?

A

if nml COPD meds fail, do course of ABX like levofloxacin

118
Q

When is long term O2 therapy indicated?

A

PaO2<88% on RA

119
Q

If acute exacerbation of COPD not resp to suplpm O2?

A

Do noninv + pressure vent, use when pts have mod/svr resp distress, use of accessory muscles, resp >25/min, pH45

120
Q

What is pulm findings w/ a1 antitrypsin deficiency?

A

leads to panacinar emphysema, leads to early onset in COPD in smkoers + nonsmokers.

121
Q

What is cryptogenic organizing pneumonia?

A

aka bronchiolitis obliterans w/ organizing pneumo — small airways and alveoli become inflammed w/ connective tissue.

122
Q

What Ab present in systemic sclerosis?

A

anti-topo1 ab (anti-SCL-70)

123
Q

When is CTA contraindicated for dx of PE?

A

when have elevated Cr due to need for lrg amount of contrast?

124
Q

How does olecranon bursitis px?

A

get tenderness to palpation over elbow but no dcrs in ROM.

125
Q

Joints typically spared by OA?

A

MCP, wrist, elbow, shoulder, ankle

126
Q

How does anserine bursitis px?

A

focal tnederness on upper medial tibia, usually in middle age pts or older, pain releif occurs w/ steroid injxn @ bursa

127
Q

What is rotator cuff tendenitis?

A

inflamm of supraspinatus +/- infraspinatus tendon w/ possible involvement of subacrom.

128
Q

If nml shoulder exam w/ shoulder pain?

A

consider causes of referred pain, do cxr and other studies.

129
Q

how does prosthetic joint infxn px?

A

usually have joint pain w/out fvr, incrsd wbc, must do arthrocentesis to dx, xray may have no findings

130
Q

Approp 1st line therapy for OA?

A

NSAIDS for sx management & PT, if NSAIDS fail or are contraindicated, can do intraarticular steroids

131
Q

When is methotrexate contraindicated?

A

if person regularly consumed ETOH. combined etoh+metho = incrsd risk of hepatotox

132
Q

Best method to establish dx of ankylosing spondyl?

A

must do MRI of sacroilliac joints

133
Q

How tx drug induced lupus? What drug rx?

A

infliximab in tx of RA can actually induce drug-induced lupus. Tx by stopping offending agent and starting steroids.

134
Q

How manage lupus GMN renal disease?

A

start high dose steroids.

135
Q

How tx Raynauds in CREST?

A

tx/ w. amlodipine (CCB), also can use a1 blockers, phosphodiesterase, endothelin receptor antagonist. 2nd line is topical nitrates on fingers

136
Q

how does fibromyalgia px?

A

diffuse pain and tenderness bilaterally & above and below waist

137
Q

How does polyarteritis nodosa px?

A

necrotizing inflammation of medium sized vessels w/out GMN or vasculitis of arterioles, smaller vessels

Uworld questions (13 decks)

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