Uworld 9 Flashcards
px of hypokalemia?
diffuse muscle weakness. GI tract atony, resp failure, cardiac arrhythmias
If equivocal findings on mammogram of mass, what is next step?
Do U/s to further eval issue
If pt has 1st degree relative w/ colon cancer, when do screening?
Do every q3-5 years, beginning 10 years earlier than first diagnosed.
What is next step in somoneone w/ + FOBT?
should receive colonscopy
What are recommendations for pulmonary nodules on CT?
If < or = 4mm, then no f/u required. If >4 mm do f/u CT in 12 months
How manage lung cancer dx w/ distant nodes?
Biopsy superficial nodes first to determine cell type. Dont need lung biopsy at first.
How managed adv stg prostate cancer
Give androgen blocker leuprolide — acts as GnRH agonist stopping prodxn of androgen
What is keratoacanthoma?
epithelial neoplasm w/ rapid growth in 2- 6 weeks.
How manage cancer related pain?
tx w/ short acting opioids. Once have proper amount of short acting, convert to long acting and use short acting for breakthrough pain.
If duodenal ulcer px, how manage?
majority due to H. Pylori, do test for h pylori then tx.
How manage gastric ulcers?
most due to H. pylori too. once dx confirmed, tx
H. pylori relationship w/ dyspepsia?
No true relation w/ GERD — no need to test w.out concern for ulcer
How w/u diverticulitis?
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
Si/sx of RCC?
weight loss, loss of appetite, change in urinary fxn
Most common metabolic alkalosis causes?
volume depletion w/ vomiting, diuretic use, excess mineralocorticoid
What is winter’s formula?
determines degree of respiratory compromise in metabolic acidois. PaCO2 = (1.5 x HCO3) + 8 +/- 2
What is equation to asses respiratory comp in metabolic alkalosis?
PaCO2 = (0.9 x HCO3) + 16 +/- 2
Nml ABG change in pregnancy?
will get incrsd resp drive — hypocapnia — resp alkalosis w/ metabolic compensation
Mst common cause of polyuria in nonhospitalized patients?
primary polydipsia, central/ nephrogenic diabetes insipidus
How does central DI px?
signif hyperNa, dilute urine, loss of thirst reflex at times
What are diff px of lacunar strokes?
pure motor hemiparesis, pure sensory stroke, ataxic hemiparesis, dysarthria-clumsy hand syndrome
What causes pure motor hemiparesis?
Lacunar stroke in posterior limb of internal capsule, px w/ unilateral motor deficit w/ mild dysarthria. no sensory problems
What causes pure sensory stroke?
stroke in ventroposterolateral nucleus of thalamus. Px w/ unilateral numbness, paresthesia, hemisensory defect in face, trunk, extrem.
What causes isolated ataxic hemiparesis?
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.
What is dysarthria- clumsy hand syndrome?
lacunar stroke in basis pontis — px w/ hand weakness, mild motor aphasia, no sens abnormalities
How manage central retinal artery occlusion?
immediately begin ocular massage & hyperoxygenation w/ hyperbaric therapy if available.
How manage acute angle closure glaucoma?
IV Diavox, pilocarpine, or beta blockers
What is relationship of statistical measures w/ “nml distribution”
mean = median = mode
What is indication for chest tube placement?
if pH of pleural fluid < 60
What middle mediastinal masses occur?
pericardial cysts, bronchogenic cysts, lymphomas, aortic aneurysm.
Most common cause of viral enceph in immunocomp patients?
HSV, varicella, EBV
How does viral enceph px? How tx?
fvr, AMS, agitation, HA, seizures, can have focal neuro abnormalities, hemiparesis, CN palsies, incrsd DTR, lymphocytosis, nml gluc, incrsd protein
How tx viral encephalitis?
tx w/ IV acyclovir
Eqtn to correct Ca if hypoalbuminemia?
Ca correc = (tot Ca) + 0.8(4-measured albumin)
How does molluscum contagiosum px?
single or multiple, rounded dome shaped papules 2/2 pox virus infxn. Common in AIDS w/ CD4<100
How tx gastric MALToma?
Curative if tx H. Pylori infxn. Do chemo if triple therapy fails.
Si/sx of aortic dissection?
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
How would ischemic hepatic injury px?
episode of septic shock or signif hypotension w/ incrs LFTs a day later, usually transient
Live enzymes in alcohlic liver disease?
AST:ALT >1.5 and AST </= 300 usually
How manage signs of aterial emboli in distal extrem (like a finger)?
likely due to afib and requires uregent vascular surgery consult.
How dx presence of foreign body w/ possible corneal damage in eye?
Do fluorescein lamp w/ slit lamp to assess
How w/u stroke in hospital?
1st do non contrast CT to detrmine if ongoing bleeding. If no bleeding then give alteplase unless >4.5 hrs since sx began.
Non-candidal cause of esophagitis in AIDS?
can be due CMV or HSV. If CMV esoph, tx w/ ganciclovir
SI/sx of CMV esophagitis?
focal substernal burning, evidence of large shallow ulcers, presence of intranuclear and intracytoplasmic inclusions
How does herpes esophagitis differ?
more, smaller, deeper volcano like ulcers w/ cells showing ballooning degen
What is hyposthenuria?
familial inability to concentrate urine that occurs w/ SCD and trait. 2/2 to sickling in vasa rectae of inner medulla w/ impaired absorption.
Early tx of parkinsons?
can start tx of tremor w/ anticholinergics (trihexyphenidyl or benztropine). Also can use carbidopa/levidopa
How dx simple cysts on CT?
should have thin wall, no solid components, no enhancement (dull/gray thruout)
Warning signs for cysts on CT?
multilocular, thickened irreg walls, septae w/in mass, contrast enhancement
What are CXR findings w/ alpha-1 antitrypsin deficiency?
Emphysemy of lower lobes bilaterally
How would intracardiac tumor px?
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
How would myxomatous degen px?
leads to MVP px w/ midsystolic click
AB assoc w/ PBC?
antimitochondrial Ab
Ab associated w/ acute/ chronic autoimmune hepatitis?
anti-smooth muscle ab, anti KLM
How w/u zencker diverticulum?
do contrast esophagram to asses aspiration risk.
How zenker diverticulum px?
regurgitated food, halitosis, neck mass
What drugs are anti-pseudomonal?
th gen cephalo, cipro, imipenem/cilastatin, tobramycin, gentamicin, amikacin, aztreonam, zosyn
What is risk of doing radioactive iodine ablation?
Damaged thyroid cells may release excess hormone causing thyrotoxicosis
Si/sx of acute liver failure?
AST and ALT > 10x nml w/ encephalopathy, impaired synthetic fxn (incrsd INR)
Causes of acute liver failure?
tylenol, viral hep, autoimmune, fatty liver of preg, Wilson’s, ischemia/sepsis, malignancy, infiltration
How w/u possible esophageal cancer?
- Barium swallow, 2. EGD, 3. PET
How dx spontaneous bacterial peritonitis?
ascitic fluid w/ segs >250, pos cx, exclusion of other causes of peritonitis, protein typ < 1g and gluc usually >50g
Most common bugs causing spb?
E coli and Klebs
Px of alport syndrome?
familial, px in kids w/ recurrent hematuria + proteinuria, sensorineural hearing loss, EM shows alternating areas of thinned and thickend capillary loops.
How would SCC of mouth px?
nonhealing ulcer px for long period, on biopsy shows invasive cords squamous cells and keratin pearls
How long are herpetic lesions usually px for?
about 2 weeks then resolve, if longer consider SCC
What is prophylactic tx for MAC in HIV?
use azithromycin, use when CD4<50
WHat occurs w/ degen joint disease of spine?
get disc herniation + osteophyte overgrowth leading to lumbar spinal stenosis?
How dx lumbar spinal stenosis?
do MRI
What is bone scan?
determines area of bone w/ high turnover, evaluates for metastatic disease, suspected fx, or osteomyelitis
Risks w/ dermatomyositis?
incrsd risk of internal malignancies — ovarian esp, also breast, urogenital cancers
What inflamm conditions incrs risk of carpal tunnel?
RA, sarcoidosis, amyloidosis
Autoimmune diseases assoc w/ renal failure?
SLE, wegners, goodpastures, scleroderma, relapsing polychondritis
Manifestations of sarcoidosis?
anter. uveitis, LAD, HSM, acute polyarthritis (esp. ankle), central DI, hypercalcemia, erythema nodosum
How definitively dx sarcoidosis?
do mediastinoscopy/ bronchoscopy
What incrses effect of warfarin?
NSAIDS, tylenol, ABX, amiodarone, cranberry, gingko, Vit E, omeprazole, phenytoin, thyroid hormone
What decrs effect of warfarin?
leafy veggies, rifampin, carbamazepine, OCPs, st. johns wart
Most common site of foci of ectopic beats causing afib?
pulmonary veins most common site
Most common mechanism of paroxysmal supravent. tachy?
most often due to reentrant into AV node
Options for tx of acute migraine episode?
triptans but must be started early, can do IV antiemetics: chlorpromazine, prochlorpromazine, metoclopramide
How does Bartter/gitelman syndrome px?
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
How manage recurrent Ca oxalate stones?
- 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
What is definition of status epilepticus?
any single seizure > 5 min, multiple seizures w/out return to neuro baseline
What is neuro risk w/ status epilepticus?
Can get cortical necorsis leading to permanent brain damage
Si/sx of malignant htn?
svr htn >/= 180/120 w/ papilledema, retinal hemorrhage
How w/u new onset Fe deficiency in elderly?
Needs colonscopy. If neg do upper GI. If both neg do capsule endoscopy.
What is fxn of nitrates?
incrs dilation of capacitance vessels (veins), dcrs preload of heart, dcrs myocardial ox demand
What is sign of severe asthma attack?
nml PaCO2, either 2/2 severe airway obstrxn leading to CO2 trapping or resp failure
What type of virus is Hep E?
RNA virus causes similar illness as Hep A.
How is hep E xmitted?
via fecally contaminated water in endemic regions. India, Asia, Africa, Central America
Who gets abdominal U/s to screen for AAA?
All current and past smokers 1x 65-75. Dont screen if a never smoker.
When use transcutaneous pacing?
used in management of symptomatic brady
How tx afib?
If unstable, need to cardiovert, if stable, rate control w/ metoprolol or IV esmolol
What is pathophys of hepatic encephalopathy?
neurotoxins that stimulate GABA & inhibit glutamate pathways in brain
How tx hepatic enceph?
give laculose or lactitol, CAn add rifaximin which kills NH4 producing bacteria
Risk of metformin in case of dcrsd renal fxn?
if renal insufficency/failure px, metformin contraindicated as incrsd risk of lactic acidosis.
How manage infective endocarditis in IV drug user?
tx w/ vanc — MRSA common cause, also covers MSSA, strep enterococci.
How manage sx ascites?
- 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.
What is salvage therapy?
form of tx used when std chemo tx fails.
How does trousseaus syndrome px?
migratory superficial thrombophlebitis — single or multiple tender, erythematous palpable cord-line veins. Should trigger w/u to find visceral tumor.
