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Uworld questions > Uworld 9 > Flashcards

Uworld 9 Flashcards

1
Q

px of hypokalemia?

A

diffuse muscle weakness. GI tract atony, resp failure, cardiac arrhythmias

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2
Q

If equivocal findings on mammogram of mass, what is next step?

A

Do U/s to further eval issue

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3
Q

If pt has 1st degree relative w/ colon cancer, when do screening?

A

Do every q3-5 years, beginning 10 years earlier than first diagnosed.

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4
Q

What is next step in somoneone w/ + FOBT?

A

should receive colonscopy

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5
Q

What are recommendations for pulmonary nodules on CT?

A

If < or = 4mm, then no f/u required. If >4 mm do f/u CT in 12 months

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6
Q

How manage lung cancer dx w/ distant nodes?

A

Biopsy superficial nodes first to determine cell type. Dont need lung biopsy at first.

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7
Q

How managed adv stg prostate cancer

A

Give androgen blocker leuprolide — acts as GnRH agonist stopping prodxn of androgen

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8
Q

What is keratoacanthoma?

A

epithelial neoplasm w/ rapid growth in 2- 6 weeks.

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9
Q

How manage cancer related pain?

A

tx w/ short acting opioids. Once have proper amount of short acting, convert to long acting and use short acting for breakthrough pain.

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10
Q

If duodenal ulcer px, how manage?

A

majority due to H. Pylori, do test for h pylori then tx.

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11
Q

How manage gastric ulcers?

A

most due to H. pylori too. once dx confirmed, tx

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12
Q

H. pylori relationship w/ dyspepsia?

A

No true relation w/ GERD — no need to test w.out concern for ulcer

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13
Q

How w/u diverticulitis?

A

initiate tx w/ PO ABX, if PO fails, do IV. If IV abx fail, suspect complicated divertic, assess w/ CT scan. DO NOT DO COLONSCOPY. or barium

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14
Q

Si/sx of RCC?

A

weight loss, loss of appetite, change in urinary fxn

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15
Q

Most common metabolic alkalosis causes?

A

volume depletion w/ vomiting, diuretic use, excess mineralocorticoid

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16
Q

What is winter’s formula?

A

determines degree of respiratory compromise in metabolic acidois. PaCO2 = (1.5 x HCO3) + 8 +/- 2

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17
Q

What is equation to asses respiratory comp in metabolic alkalosis?

A

PaCO2 = (0.9 x HCO3) + 16 +/- 2

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18
Q

Nml ABG change in pregnancy?

A

will get incrsd resp drive — hypocapnia — resp alkalosis w/ metabolic compensation

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19
Q

Mst common cause of polyuria in nonhospitalized patients?

A

primary polydipsia, central/ nephrogenic diabetes insipidus

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20
Q

How does central DI px?

A

signif hyperNa, dilute urine, loss of thirst reflex at times

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21
Q

What are diff px of lacunar strokes?

A

pure motor hemiparesis, pure sensory stroke, ataxic hemiparesis, dysarthria-clumsy hand syndrome

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22
Q

What causes pure motor hemiparesis?

A

Lacunar stroke in posterior limb of internal capsule, px w/ unilateral motor deficit w/ mild dysarthria. no sensory problems

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23
Q

What causes pure sensory stroke?

A

stroke in ventroposterolateral nucleus of thalamus. Px w/ unilateral numbness, paresthesia, hemisensory defect in face, trunk, extrem.

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24
Q

What causes isolated ataxic hemiparesis?

A

can be due to lacunar stroke in anterior limb of internal capsule, have weakness more prominent in lower extrem w/ ipsilateral arm and leg incoordination.

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25
Q

What is dysarthria- clumsy hand syndrome?

A

lacunar stroke in basis pontis — px w/ hand weakness, mild motor aphasia, no sens abnormalities

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26
Q

How manage central retinal artery occlusion?

A

immediately begin ocular massage & hyperoxygenation w/ hyperbaric therapy if available.

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27
Q

How manage acute angle closure glaucoma?

A

IV Diavox, pilocarpine, or beta blockers

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28
Q

What is relationship of statistical measures w/ “nml distribution”

A

mean = median = mode

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29
Q

What is indication for chest tube placement?

A

if pH of pleural fluid < 60

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30
Q

What middle mediastinal masses occur?

A

pericardial cysts, bronchogenic cysts, lymphomas, aortic aneurysm.

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31
Q

Most common cause of viral enceph in immunocomp patients?

A

HSV, varicella, EBV

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32
Q

How does viral enceph px? How tx?

A

fvr, AMS, agitation, HA, seizures, can have focal neuro abnormalities, hemiparesis, CN palsies, incrsd DTR, lymphocytosis, nml gluc, incrsd protein

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33
Q

How tx viral encephalitis?

A

tx w/ IV acyclovir

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34
Q

Eqtn to correct Ca if hypoalbuminemia?

A

Ca correc = (tot Ca) + 0.8(4-measured albumin)

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35
Q

How does molluscum contagiosum px?

A

single or multiple, rounded dome shaped papules 2/2 pox virus infxn. Common in AIDS w/ CD4<100

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36
Q

How tx gastric MALToma?

A

Curative if tx H. Pylori infxn. Do chemo if triple therapy fails.

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37
Q

Si/sx of aortic dissection?

A

chest pain radiating to back, svr htn, decrescendo diastolic murmur @ R sternal border of 4th intercostal space. ECG shows LVH, T wave invrsn @ V5 and V6

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38
Q

How would ischemic hepatic injury px?

A

episode of septic shock or signif hypotension w/ incrs LFTs a day later, usually transient

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39
Q

Live enzymes in alcohlic liver disease?

A

AST:ALT >1.5 and AST </= 300 usually

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40
Q

How manage signs of aterial emboli in distal extrem (like a finger)?

A

likely due to afib and requires uregent vascular surgery consult.

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41
Q

How dx presence of foreign body w/ possible corneal damage in eye?

A

Do fluorescein lamp w/ slit lamp to assess

42
Q

How w/u stroke in hospital?

A

1st do non contrast CT to detrmine if ongoing bleeding. If no bleeding then give alteplase unless >4.5 hrs since sx began.

43
Q

Non-candidal cause of esophagitis in AIDS?

A

can be due CMV or HSV. If CMV esoph, tx w/ ganciclovir

44
Q

SI/sx of CMV esophagitis?

A

focal substernal burning, evidence of large shallow ulcers, presence of intranuclear and intracytoplasmic inclusions

45
Q

How does herpes esophagitis differ?

A

more, smaller, deeper volcano like ulcers w/ cells showing ballooning degen

46
Q

What is hyposthenuria?

A

familial inability to concentrate urine that occurs w/ SCD and trait. 2/2 to sickling in vasa rectae of inner medulla w/ impaired absorption.

47
Q

Early tx of parkinsons?

A

can start tx of tremor w/ anticholinergics (trihexyphenidyl or benztropine). Also can use carbidopa/levidopa

48
Q

How dx simple cysts on CT?

A

should have thin wall, no solid components, no enhancement (dull/gray thruout)

49
Q

Warning signs for cysts on CT?

A

multilocular, thickened irreg walls, septae w/in mass, contrast enhancement

50
Q

What are CXR findings w/ alpha-1 antitrypsin deficiency?

A

Emphysemy of lower lobes bilaterally

51
Q

How would intracardiac tumor px?

A

would have mid-diast rumble @ apex 2/2 mitral valve obstrxn, px w/ fatigue, low grd fvrs, tumor can embolize causing embolic stroke, other embolic complications

52
Q

How would myxomatous degen px?

A

leads to MVP px w/ midsystolic click

53
Q

AB assoc w/ PBC?

A

antimitochondrial Ab

54
Q

Ab associated w/ acute/ chronic autoimmune hepatitis?

A

anti-smooth muscle ab, anti KLM

55
Q

How w/u zencker diverticulum?

A

do contrast esophagram to asses aspiration risk.

56
Q

How zenker diverticulum px?

A

regurgitated food, halitosis, neck mass

57
Q

What drugs are anti-pseudomonal?

A

th gen cephalo, cipro, imipenem/cilastatin, tobramycin, gentamicin, amikacin, aztreonam, zosyn

58
Q

What is risk of doing radioactive iodine ablation?

A

Damaged thyroid cells may release excess hormone causing thyrotoxicosis

59
Q

Si/sx of acute liver failure?

A

AST and ALT > 10x nml w/ encephalopathy, impaired synthetic fxn (incrsd INR)

60
Q

Causes of acute liver failure?

A

tylenol, viral hep, autoimmune, fatty liver of preg, Wilson’s, ischemia/sepsis, malignancy, infiltration

61
Q

How w/u possible esophageal cancer?

A
  1. Barium swallow, 2. EGD, 3. PET
62
Q

How dx spontaneous bacterial peritonitis?

A

ascitic fluid w/ segs >250, pos cx, exclusion of other causes of peritonitis, protein typ < 1g and gluc usually >50g

63
Q

Most common bugs causing spb?

A

E coli and Klebs

64
Q

Px of alport syndrome?

A

familial, px in kids w/ recurrent hematuria + proteinuria, sensorineural hearing loss, EM shows alternating areas of thinned and thickend capillary loops.

65
Q

How would SCC of mouth px?

A

nonhealing ulcer px for long period, on biopsy shows invasive cords squamous cells and keratin pearls

66
Q

How long are herpetic lesions usually px for?

A

about 2 weeks then resolve, if longer consider SCC

67
Q

What is prophylactic tx for MAC in HIV?

A

use azithromycin, use when CD4<50

68
Q

WHat occurs w/ degen joint disease of spine?

A

get disc herniation + osteophyte overgrowth leading to lumbar spinal stenosis?

69
Q

How dx lumbar spinal stenosis?

A

do MRI

70
Q

What is bone scan?

A

determines area of bone w/ high turnover, evaluates for metastatic disease, suspected fx, or osteomyelitis

71
Q

Risks w/ dermatomyositis?

A

incrsd risk of internal malignancies — ovarian esp, also breast, urogenital cancers

72
Q

What inflamm conditions incrs risk of carpal tunnel?

A

RA, sarcoidosis, amyloidosis

73
Q

Autoimmune diseases assoc w/ renal failure?

A

SLE, wegners, goodpastures, scleroderma, relapsing polychondritis

74
Q

Manifestations of sarcoidosis?

A

anter. uveitis, LAD, HSM, acute polyarthritis (esp. ankle), central DI, hypercalcemia, erythema nodosum

75
Q

How definitively dx sarcoidosis?

A

do mediastinoscopy/ bronchoscopy

76
Q

What incrses effect of warfarin?

A

NSAIDS, tylenol, ABX, amiodarone, cranberry, gingko, Vit E, omeprazole, phenytoin, thyroid hormone

77
Q

What decrs effect of warfarin?

A

leafy veggies, rifampin, carbamazepine, OCPs, st. johns wart

78
Q

Most common site of foci of ectopic beats causing afib?

A

pulmonary veins most common site

79
Q

Most common mechanism of paroxysmal supravent. tachy?

A

most often due to reentrant into AV node

80
Q

Options for tx of acute migraine episode?

A

triptans but must be started early, can do IV antiemetics: chlorpromazine, prochlorpromazine, metoclopramide

81
Q

How does Bartter/gitelman syndrome px?

A

due to Na + Cl channel dysfxn in kidney, get polyuria, polydipsia, growth + MR, have high urine chloride, nml serine sodium, activation of RAA axis. No HTN

82
Q

How manage recurrent Ca oxalate stones?

A
  1. incrs fluid intake > 3 L day. 2. nl or incrs Ca in diet. 3. restrict sodium intake, thiazide diuretic tx, 4. oxalate restiction, protein restriction
83
Q

What is definition of status epilepticus?

A

any single seizure > 5 min, multiple seizures w/out return to neuro baseline

84
Q

What is neuro risk w/ status epilepticus?

A

Can get cortical necorsis leading to permanent brain damage

85
Q

Si/sx of malignant htn?

A

svr htn >/= 180/120 w/ papilledema, retinal hemorrhage

86
Q

How w/u new onset Fe deficiency in elderly?

A

Needs colonscopy. If neg do upper GI. If both neg do capsule endoscopy.

87
Q

What is fxn of nitrates?

A

incrs dilation of capacitance vessels (veins), dcrs preload of heart, dcrs myocardial ox demand

88
Q

What is sign of severe asthma attack?

A

nml PaCO2, either 2/2 severe airway obstrxn leading to CO2 trapping or resp failure

89
Q

What type of virus is Hep E?

A

RNA virus causes similar illness as Hep A.

90
Q

How is hep E xmitted?

A

via fecally contaminated water in endemic regions. India, Asia, Africa, Central America

91
Q

Who gets abdominal U/s to screen for AAA?

A

All current and past smokers 1x 65-75. Dont screen if a never smoker.

92
Q

When use transcutaneous pacing?

A

used in management of symptomatic brady

93
Q

How tx afib?

A

If unstable, need to cardiovert, if stable, rate control w/ metoprolol or IV esmolol

94
Q

What is pathophys of hepatic encephalopathy?

A

neurotoxins that stimulate GABA & inhibit glutamate pathways in brain

95
Q

How tx hepatic enceph?

A

give laculose or lactitol, CAn add rifaximin which kills NH4 producing bacteria

96
Q

Risk of metformin in case of dcrsd renal fxn?

A

if renal insufficency/failure px, metformin contraindicated as incrsd risk of lactic acidosis.

97
Q

How manage infective endocarditis in IV drug user?

A

tx w/ vanc — MRSA common cause, also covers MSSA, strep enterococci.

98
Q

How manage sx ascites?

A
  1. Na/H2o restrxn, 2. diuretics (begin w/ spironolactone, then lasix) 3. slow daily tapping of 2-4 L ascitic fluid w/ freq renal fxn checks.
99
Q

What is salvage therapy?

A

form of tx used when std chemo tx fails.

100
Q

How does trousseaus syndrome px?

A

migratory superficial thrombophlebitis — single or multiple tender, erythematous palpable cord-line veins. Should trigger w/u to find visceral tumor.

Uworld questions (13 decks)

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