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UWorld c Flashcards

1
Q

2 classes of calcium channel blockers

A

Dihydropyridines- used to reduce systemic vascular resistance and arterial pressure

  • amlodipine
  • nicardipine
  • nifedipine

Non-dihydropyridine- relatively select for the myocardium to reduce myocardial O2 demand and reverse coronary vasospasm

  • verapamil
  • diltiazem
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2
Q

3 top Ddx for vaginitis

(b) Tx for each

A

Vaginitis:
1. BV = bacterial vaginosis from gardnerella vaginalis
Tx- flagyl or clinda

  1. Trichomoniasis from trichomonas vaginalis
    Tx- flagyl, treat sexual partner
  2. Candida vaginitis from candida albicans
    Tx -fluconazole
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3
Q

Distinguish 3 causes of vaginitis

(a) Discharge
(b) Lab findings

A

Vaginitis

  1. Gardnerella vaginalis (BV)
    (a) Thin, off white discharge w/ fishy odor
    (b) Clue cells, positive whiff test (amine odor w/ KOH)
  2. Trichomoniasis
    (a) Thin, yellow-green malodorous discharge w/ vaginal inflammation
    (b) Motile trichomonads
  3. Candida vaginitis
    (a) Thick cottage cheese discharge
    (b) Pseudohyphae
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4
Q

Buzzwords for vaginitis

(a) Fish odor
(b) Clue cells
(c) Pseudohyphae
(d) Motile trichomonads
(e) Cottage cheese (thick) discharge
(f) Positive whiff test

A

(a) Fishy odor = off-white thin discharge of BV (gardnerella)
(b) Clue cells = BV, gardnerella
(c) Pseudohyphae = lab finding of candida vaginalis (cottage cheese thick discharge)
(d) Motile trichomonads = trichomoniasis = thin yellow/green malodorous (but not ‘fishy’) discharge
(e) Cottage cheese discharge = candida vaginalis
(f) Positive whiff test = amine odor w/ KOH

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5
Q

Which type of vaginitis should you also treat the partner?

A

Tx pt and sexual partner for trichomoniasis (flagyl to both pt and partner): even for asymptomatic pts (for F if found incidentally on pap)

-don’t need to tx partner for BV (gardnerella) or candida vaginitis

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6
Q

Clinical features of chronic adrenal insufficiency

A

Chronic adrenal insufficiency (MC cause Addison’s): weight loss, hyperpigmentation (brown spots on lip/face), abd pain, fatigue, myalgias, decreased axillary and pubic hair

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7
Q

Lab abnormalities consistent with Addison’s disease

A

BMP abnormality in chronic adrenal insufficiency (autoimmune = Addison’s)

  • hyponatremia (85-90% of pts w/ Addisons): due to low aldo
  • hyperkalemia: due to low aldo (aldo stimulates urinary K secretion)
  • mild hyperchloremic metabolic acidosis (H+ retention by kidneys from low aldo)

Diagnostic = low cortisol w/ elevated ACTH

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8
Q

Clinical features of tabes dorsalis

A

Tabes dorsalis = treponeal spirochetes directly damage dorsal sensory roots

  1. sensory ataxia: positive Romberg, reduced sensation to pain/temp/vibration/proprioception
  2. lancinating pains: brief shooing or burning pain (ex: 45 y/oM shooting and burning pain in legs)

Argyll Robertson pupils = normal pupillary construction w/ accommodation but not to light

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9
Q

Bacterial vs. viral meningitis

(a) Expected white count
(b) Expected protein

A

Bacterial meningitis

(a) WBC over 1,000
(b) Protein over 250 (high!)

Viral meningitis

(a) WBC 10-500
(b) Protein under 150 (viruses not all filled w/ proteins)

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10
Q

Define solitary pulmonary nodule

(b) First step in mgmt

A

Solitary pulmonary nodule= round opacity 3 cm or less in diameter surrounded by pulmonary parenchyma

(b) Compare to prior imaging, if no prior imaging or change in size/appearance => CT
- see other smaller nodules
- characterize (fully surrounded by pulmonary parenchyma? spiculated borders?)

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11
Q

Valgus vs. varus laxity of the knee

A

Valgus laxity = insability w/ lateral movement = damage to medial collateral ligament

Varus = instability w/ medial movement of the knee = damage to lateral collateral ligament

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12
Q

Clinical features of tear in cruciate vs collateral ligaments of the knee

A 
Cruciate ligaments (anterior, posterior) come w/ anterior/posterior laxiety
-large effusion/hemarthrosis usually pressent
Collateral ligament (medial, lateral): instability w/ lateral vs. medial movement
-effusion uncommon
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13
Q

Options to help pts w/ PCOS get pregnant

A

Can’t do OCPs to regulate menstruation if pt wants to get pregnant!

First line tx = weight loss, weight loss restores ovulation (b/c in PCOS infertility is 2/2 anovulation)
Then can use clomiphene citrate for ovulation induction (before having to go to IVF)

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14
Q

Paget’s disease

(a) What is it
(b) Lab values
(c) First line tx

A

Paget’s disease

(a) Disorder of increased bone turnover
(b) Elevated alk phos w/ normal calcium (and normal LFTs)
(c) Bisphosphonates- to reduce bone turnover

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15
Q

Pseudohypertrophy of the calves

(b) Next lab test

A

= Gower’s sign
Buzzword for Duchenne’s muscular dystrophy = defective dystrophin gene on X-chromosome

(b) Elevated CK

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16
Q

First line tx for Raynaud’s phenomenon

A

Dihydropyridine (peripheral, not cardiac selective) calcium channel blocker = nifedipine or amlodipine

(not verapamil or dilt = non-dihydropyridine)

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17
Q

During surgery for pheochromocytoma removal, how would you manage

(a) Hypotension
(b) Acute severe hypertension

A

(a) Hypotension due to rapid removal of catecholamines- give fluids, maybe pressors if needed
- also preop alpha blockade may reduce vascular tone => need vaso

(b) Acute severe hypertension from high catecholamine release from adrenal gland handling => IV nitroprusside, phentolamine, or nicardipine

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18
Q

Age cutoff to watch and wait in cryptorchidism

A

Cryptorchidism = undescended tests

By 6 months of age (corrected for gestation) referral for surgery (orchiopexy = surgical fixation of testis to scrotal wall) is indicated

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19
Q

Name 3 things that increased the risk of bleeding diathesis in colonic angiodysplasias

A

Cherry-red lesions on endoscopy/colonoscopy = angiodysplasis (vascular ectasias or AV malformations)

More likely to bleed in

  1. ESRD
  2. Aortic stenosis: sheer stress of RBCs from turbulence
  3. von willebrand disease: vWF most active in vascular beds w/ high sheer stress
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20
Q

Breast milk jaundice vs. breast feeding failure jaundice

(a) TIming
(b) Presentation
(c) Tx

A

Breast milk jaundice

(a) First 1-2 weeks
(b) Indirect hyperbili due to enzyme in breast milk, normal exam, adequate breastfeeding
(c) Nada, keep chillin and breastfeeding

Breast feeding failure jaundice

(a) Early, first week of life
(b) Losing weight, dehydrated
(c) Formula feed supplement

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21
Q

Key factors to distinguish migraines vs. cluster headache

A

Both unilateral, can have photophobia

Cluster- associated w/ trigeminal autonomic hyperactivity (lacrimation, conjunctival injection, rhinorrhea, nasal congestion)

Ex: 41 y/oM w/ h/o HA increasing in frequency, bad HA behind his left eye w/ sweaty forehead and watery L eye

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22
Q

Cluster headaches tx

(a) Acute management/abortive measures
(b) Prophylaxis after more than 2 months

A

(a) 100% O2 via nonrebreather provides relief in over 70% pts
- second line: intranasal sumatriptan in nostril contralateral to side of headache

(b) Ppx- verapamil

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23
Q

First line tx for persistent/severe RLS

A

Pramipexole = dopamine agonists

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24
Q

Neurologic exam findings consistent with brain death

A

Absence of cerebral and brainstem reflexes: non pupillary/corneal/gag reflexes in brain death

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25
Q

35 y/o pilot p/w joint pain

  • trip 3 months ago had fever and malaise for several days, followed by pain in fingers/wrists/ankles
  • since then: severe joint pain

Dx?

A

Chikungunya fever

Illness script: mosquito (same one as Dengue and Zika) borne w/ 3-5 days of high fevers (102) followed by symmetric distal joint pains (wrists, hands, ankles)

Then about 30% develop chronic joint pains, some so severe as requiring MTX

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26
Q

Typical lab abnormalities seen in malaria

A

Anemia and hyperbilirubinemia 2/2 RBC lysis

-mosquito-borne protozoal illness

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27
Q

Illness script for typhoid fever

A

After incubation period of ingesting salmonella-infected food/water p/w stepwise increasing fever, relative bradycardia

2nd week- abdominal pain and rose spots (faint salmon colored 1-2mm macules on trunk and abdomen)

3rd week- HSM, intestinal bleeding, intestinal perf 2/2 ileocecal lymphatic hyperplasia of Peyer’s patches

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28
Q

Upper vs lower motor neuron lesion would cause:

(a) Atrophy
(b) Absent DTRs
(c) Flaccid paralysis
(d) Hypertonia
(e) Fasiculations

A

UMN lesion

(a) no (minimal) atrophy (only due to disuse)
(b) Hyperreflexia
(c) Spastic paralysis
(d) Hypertonic
(e) No fasiculations

LMN lesion

(a) Marked atrophy
(b) DTRs absent
(c) Flaccid paralysis
(d) Hypotonic
(e) Yes fasiculations

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29
Q

How to distinguish ALS from brainstem tumor

A

Both can cause both UMN and LMN signs (ex: hyperactive knee jerk (UMN), R thigh atrophy and fasciculations (LMN))

In ALS: ocular motility, sensory, bowel, bladder, and cognitive fxns are preserved even in advanced disease

Would expect pain, sensory changes, bowel/bladder dysfunction in brainstem tumor

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30
Q

What type of hypersensitivty reaction is:

(a) Serum sickness
(b) Autoimmune hemolytic anemia
(c) PCN allergy
(d) Contact dermatitis

A

HS reaction

(a) Serum sickness = immune complex mediated = type III
(b) AIHA = antibody mediated = type II (another ex: Goodpastures)
(c) PCN allergy = fast IgE mediated = type I (like anaphylaxis)
(d) Contact dermatitis = delayed, T cell mediated = type IV

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31
Q

What type of hypersensitivty reaction is:

(a) Acute graft vs host
(b) Chronic graft rejection

A

Hypersensitivity Rxn

(a) Acute GVH = antibody mediated = type II
(b) Chronic graft rejection = T cell mediated = type IV (another ex: contact dermatitis)

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32
Q

Drug of choice for mammal (including human) bites

A

Augmentin (amox/clavulanate) to cover for oral aerobes and abaerobes including Eikenella corrodens (anaerobe found in human mouth)

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33
Q

Post-stroke

(a) Time window for tPA
(b) BP goal with and w/o tPA

A

Post-stroke

(a) If no contraindications (hemorrhagic conversion, intracranial mass, plts under 100k, INR over 1.7) can give if under 3-4.5 hours of symptom onset

(b) BP goal
under 220/110 if no tPA use
if tPA used slightly stricter goal under SBP 185 to minimize risk of intracranial hemorrhage

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34
Q

MC bug caused by ear infection associated w/

(a) Following water exposure
(b) Purulent unilateral ear drainage

A

(a) Pain on external ear manipulation = bacterial otitis externa
MC bug pseudomonas
usually following water exposure

(b) Suppurative otitis media MC from group A strep
middle ear cavity infected by bacteria from the nasopharynx

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35
Q

Differentiating features of pediatric neck masses

(a) Thyroglossal duct cyst
(b) Dermoid cyst
(c) Brachial cleft cyst

A

(a) Thyroglossal duct cyst from embryologic failure of duct to atrophy normally (as thyroid forms as outpouching from the base of the tongue then descends via thyroglossal duct)
Medial
Displaces superiorly w/ protrusion of tongue

(b) Dermoid cyst = midline, but no displacement w/ tongue protrusion
Contain cutaneous structures (hair follicles, sebaceous glands)

(c) Brachial cleft cyst = embryologic remnant anterior to SCM muscle.
Neck mass is lateral
Can have associated sinus tract or fistula

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36
Q

MC complication of transurethral resection of the prostate

A

TURP for mgmt of BPH

MC complication = retrograde ejaculation

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37
Q

Triad of symptoms in Meniere’s

(b) Differentiate from BPPV

A

Meniere’s triad = periodic vertigo/dizziness, unilateral hearing loss, unilateral tinnitus

(b) BPPV- no accompanied hearing loss

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38
Q

Clinical features of testicular torsion

A

Severe unilateral testicular pain, elevated and transverse testis (b/c spermatic cord is twisted on itself)

  • *absence of cremasteric reflex (testis should reflexively elevate on stroking of upper inner thigh)
  • no pain relief w/ scrotal elevation (seen in epididymitis)
39
Q

Tx of bacterial conjunctivitis

A

First line = erythromycin ointment or polymyxin-trimethoprim drops

BUTTT if contact wearers- first line is fluoroquinolone (ex: cipro) given higher risk for pseudomonas

40
Q

When does a cleft lip get repaired?

A

Rule of 10

  • 10 lbs of weight
  • 10 weeks old (3 months ish)
  • 10 g hemoglobin
41
Q

Anterior uveitis

(a) Clinical features
(b) Pupil findings
(c) Slit lam exam findings

A

Anterior uveitis = iritis

(a) pain, redness, variable vision loss
(b) Constricted and irregular pupil
(c) Characteristic leukocytes in anterior segment confirms diagnosis

42
Q

Ramsay Hunt Syndrome- clinical features

A

= herpes zoster oticus = reactivated VZV

-ear pain, external auditory vesicles, ipsilateral facial paralysis

43
Q

72 y/oF w/ HTN/DM p/w R ear pain and drainage x2 days, tenderness w/ motion of R earlobe, purulent drainage and granulation tissue on external auditory canal

(a) Dx
(b) MC cause
(c) Tx

A

(a) Malignant otitis externa- external otitis media that progressed to involve adjacent bones at base of the skull
- marked pain
- systemic signs (fever) common
- granulation tissue pathognomonic but not always present
(b) 95% due to pseudomonas
(c) Tx w/ cipro

44
Q

Testicular cancer

(a) Typical clinical presentation
(b) Workup
(c) Typical treatment

A

(a) Young male (15-35), possible h/o cryptorchidism (undescended testes) p/w unilateral painless firm ovoid testicular nodule
(b) Start w/ scrotal ultrasound- firm hard testicle that does not transilluminate. Then serum tumor markers (AFP, beta-hCG).
(c) Radical orchiectomy- both remove and get tissue diagnosis, that + chemo gives 95% cure rate

45
Q

How to distinguish viral from allergic conjunctivitis

A

Viral- commonly w/ prodrome, uni or bilateral, watery or mucoid discharge, pain w/o itchiness

Allergic- always b/l, watery discharge only, itchiness is characteristic

46
Q

Clinical presentation of keratitis

A

Keratitis = corneal inflammation

Pain, impaired sight, photophobia, red eye, ‘gritty’ sensation

So not painless (like central retinal artery/vein occlusion)
Photophobia

47
Q

Tx of foreign-body corneal abrasion

(b) MC organism

A

Erythromycin or cipro eye drops or ointments

b) MC overal is coag negative staph (ex: staph epi
MC in contact wearers = pseudomonas (so use cipro for them)

48
Q

Mastoiditis

(a) Clinical features
(b) Treatment
(c) MC organism

A

Mastoiditis = bacterial infxn of mastoid air cells, complication of acute otitis media
Inflammation from middle ear extends to mastoid cavity, purulent material causes bony destruction

(a) fever, ear pain, otorrhea (ear discharge), also w/ protrusion of auricle (ear sticking out of head)
(b) Tx = IV abx (vanc) and drainage of mdidle ear
(c) MC pathogens: strep pneumo, strep pyogenes, staph aureus

49
Q

Cause of elevated PSA that aren’t cancer

A
  • urinary retention (so if pt admitted for urinary retention found to have elevated PSA, repeat in 6-8 weeks to see if real)
  • prostatitis
  • urologic procedure (ex: cystoscopy)
  • recent ejaculation
  • BPH
50
Q

32 y/oF p/w tenderness at McBurney’s point

(a) Diagnosis
(b) Possible consequence of inadequate treatment

A

(a) Appendicitis
(b) Pylephebitis = infective suppurative portal vein thrombosis- rare but devastating complication of intraabdominal infections (pelvic infections, diverticulitis)

51
Q

At what part of the pathway (UMN, peripheral nerve, NMJ, muscle fiber) do the following act

(a) Vit B12 deficiency
(b) Guillain-Barre
(c) Hypothyroidism
(d) Organophosphate poisoning
(e) Botulism
(f) Lead poisoning
(g) Myasthenia gravis

A

(a) Vit B12 affects UMN
(b) Guillain-Barre = autoimmune demyelination of peripheral nerves
(c) Hypothyroidism- level of the muscle
(d) Organophosphate poisoning- level of NMJ (inhibits achetylcholinesterase => cholinergic toxicity)
(e) Botulism- level of NMJ (neurotoxin inhibits presynaptic ACh release into NMJ)
(f) Lead poisoning- peripheral nerve
(g) MG- NMJ, ACh-receptor antibodies

52
Q

Paralysis seen in

(a) Botulism
(b) Guillain-Barre

A

(a) Botulism = descending paralysis

(b) Guillain-Barre = ascending paralysis

53
Q

MC clinical symptoms of

(a) PBC
(b) Wilson’s disease
(c) Hemochromatosis

A

(a) PBC- fatigue and pruritis
(b) Neuropsych features: depression, dysarthria, gait issues, chorea/parkinsonism
(c) men, hyperpigmentation, diabetes (bronze diabetes)

54
Q

NF1 clinical features

A

NF1: cafe au lait spots in childhood, inguinal freckling

neurofibromas = benign tumors of peripheral nerves of the skin

55
Q

PBC

(a) Treatment
(b) Nutritional complication

A

(a) Tx- urosdeoxycholic acid slows progression and improves transplant free survival
(b) Progressive bone loss- associated w/ metabolic bone disease (osteopenia and osteoporosis)

56
Q

Clinical features of organophosphate poisoning

A

Organophosphates (farms) inhibits ACh-ase => cholinergic toxicity

Muscarinic effects = DUMBELS
Defecation
Urination
Miosis (pinpoint pupils)
Bronchospasm/bradycardia
Emesis
Lacrimation
Salivation

ex: 22 y/o farm hand p/w cough and SOB, pinpoint pupils, copious airway secretions, clothes spoiled w/ stool and urine

57
Q

How to diagnose carbon monoxide poisoning

A

Dx by carboxyhemoglobin level on ABG (pulse ox will be 100% b/c it cannot distinguish carboxyHb and oxyHb)

NOT methemaglobin which is from oxidation of iron molecules in Hb preventing O2 binding

58
Q

MEN2a vs. MEN2b

A

Both: medullary thyroid cancer and pheochoromocytoma

MEN2a: + parathyroid hyperplasia

MEN2b: + mucosal neuromas/marfanoid habitus

59
Q

Kussmal breathing

A

Rapid and deep breathing pattern

ex: respiratory compensation to severe metabolic acidosis

60
Q

Antifreeze

(a) Compound name
(b) Tx of antifreeze

A

Antifreeze = (a) Ethylene glycol

(b) Fomepizole = alcohol dehydrogenase competitive inhibitor
- Ethanol use (AD has greater affinity for ethanol than other alcohols) not suggested in fomepizole (more potent ADH inhibitor) is available

61
Q

MC blood transfusion reaction

(b) Mechanism
(c) How to treat/prevent

A

MC = febrile nonhemolytic rxn 1-6 hrs after starting transfusion

(b) Reaction to cytokines released by leukocytes while blood parts are in storage
(c) Prevent next time by using leukoreduced blood products for the next transfusion
- leukoreduced = reduce number of transfused leukocytes, also reduces HLA

62
Q

Type of specialized RBC treatment that should be used in

(a) Pts who have had previous febrile nonhemolytic transfusion reactions
(b) Pts w/ IgA deficiency
(c) Bone marrow transplant recipients

A

(a) Use leukoreduced (aka reduced number of leukocytes) in pts w/ febrile rxns b/c fever is thought to be 2/2 cytokines released by leukocytes while blood products are in storage
(b) Washed RBCs in IgA deficiency b/c these pts have anti-IgA antibodies which would react w/ IgA in donor blood => anaphylaxis
(c) BMT recipients- irradiated

63
Q

Oral chelation agent used in

(a) Moderate asymptomatic lead poisoning
(b) Wilson’s

A

(a) Serum Pb 45-69 = moderate, treat w/ DMSA, succimer to chelate- binds Pb in blood to increased urinary secretion
(b) D-penicillamine- primary chelating tx for copper removal in Wilsons

64
Q

Venous lead levels associated with

(a) Requiring chelation therapy
(b) Seizures

A

Venous lead levels over 5 is abnormal

5-44 is mild, requires removal of exposure and repeat venous level in 1 month

(a) Over 45 is moderate and severe => chelation with DMSA, EDTA
(b) Acute encephalopathy (AMS, seizures) in very severe w/ venous levels over 100

65
Q

65 y/oF in workup pre-CABG is found to have hypothyroidism w/o symptoms of myxedema coma- go ahead w/ surgery? Start levothyroxine?

A

Go ahead w/ surgery w/o starting synthroid

Synthroid can increase myocardial O2 demand => start low and go slow in pts w/ CAD

66
Q

What is achalasia?

(b) Finding on esophagram
(b) Infectious cause of secondary achalasia

A

Achalasia- failure of lower esophageal sphincter relaxation due to degeneration of ganglia in Auerbach plexus

(b) Dilated esophagus w/ birds beak narrowing distally
(c) Typanosoma cruzi (chagas)

67
Q

Plummer-Vinson syndrome

(b) Tx

A

Plummer-Vinson = triad of

  1. iron deficiency anemia
  2. dysphagia
  3. esophageal web

(b) Iron repletion- generally improves esophageal web

68
Q

Iron deficiency anemia vs. thalassemia

(a) MCV
(b) Peripheral smear
(c) Ferritin

A

(a) Both microcytic
(b) Microcytosis and hypochromia for IDA. Target cells for thal
(c) Ferritin low in IDA, normal or high in thal

69
Q

Thalassemia vs. physiologic anemia of pregnancy

A

Thal- microcytic, hypochromic

Physiologic of pregnancy- normocytic, normal RDW, just diluted essentially

70
Q

Renal ultrasound w/ multiple b/l cysts

(a) Diagnosis, clinical features
(b) Next step in management
(c) Neurologic complication
(d) Cardiac complications

A

(a) Autosomal dominant PCKD. Hematuria, flank pain, HTN, palpable abdominal masses, proteinuria
(b) ACEi for good BP control
(c) Cerebral berry aneurysms
(d) Valvue disorders- mitral valve prolapse, aortic regurg

71
Q

ADPCKD

(a) How to make diagnosis
(b) How to screen in ppl w/ fam Hx

A

Autosomal dominant polycystic kidney disease

(a) Clinically (palpable kidney masses, HTN, renal disease, flank pain, proteinuria) then renal ultrasound
- dont need expensive genetic testing for dx

(b) Screen pts over age 18 w/ family history w/ renal ultrasound
(not more expensive genetic testing)

72
Q

32 y/oF p/w tenderness at McBurney’s point

(a) Diagnosis
(b) Possible consequence of inadequate treatment

A

(a) Appendicitis
(b) Pylephebitis = infective suppurative portal vein thrombosis- rare but devastating complication of intraabdominal infections (pelvic infections, diverticulitis)

73
Q

(a) Anti-smooth muscle Ab
(b) Antimitochondrial Ab
(c) Anti-citrullinated peptide Ab

A

(a) Anti-smooth muscle = autoimmune hepatitis, expect transaminitis
(b) Antimitochondrial = PBC, highly sensitive (95%) and specific for PBC, expect higher alk phos than transaminitis
(c) Anti-citrullinated peptide Ab = high specificity for RA, so in pt w/ polyarthritis it can help differentiate RA

74
Q

Typical clinical presentation of Wilson disease

(b) Blood test for diagnosis

A

Pt before age 35 p/w hepatomegaly and transaminitis, frequent neuropyschiatric symptoms (depression, movement d/o)

(b) Low ceruloplasmin
- due to abnormal transport and metabolism of copper

75
Q

MC clinical symptoms of

(a) PBC
(b) Wilson’s disease
(c) Hemochromatosis

A

(a) PBC- fatigue and pruritis
(b) Neuropsych features: depression, dysarthria, gait issues, chorea/parkinsonism
(c) men, hyperpigmentation, diabetes (bronze diabetes)

76
Q

Antimitochondrial Ab+

(a) Diagnosis
(b) Mechanism of disease

A

(a) PBC

(b) Progressive autoimmune disease: fibrosis and obliteration of intrahepatic ducts leading to cirrhosis

77
Q

PBC

(a) Treatment
(b) Nutritional complication

A

(a) Tx- urosdeoxycholic acid slows progression and improves transplant free survival
(b) Progressive bone loss- associated w/ metabolic bone disease (osteopenia and osteoporosis)

78
Q

Typical clinical presentation of myasthenia gravis

A

Progressive weakness, worsens throughout the day, most commonly of ocular and bulbar muscles => ptosis and intermittent dysphagia

79
Q

29 yoF w/ h/o GIB due to large gastric ulcer p/w hypercalcemia. Mother has h/o syptomatic hypercalcemia and pituitary tumor

Suspected diagnosis?

A

MEN1: 3 P’s

  1. Pituitary adenoma
  2. Primary hyperparathyroidism- most common manifestation
  3. Pancreatic tumor- gastrinoma (recurrent peptic ulcers), glucagonoma, insulinoma, VIPoma
80
Q

MEN2a vs. MEN2b

A

Both: medullary thyroid cancer and pheochoromocytoma

MEN2a: + parathyroid hyperplasia

MEN2b: + mucosal neuromas/marfanoid habitus

81
Q

Clinical features of Sturge-Weber syndrome

A

Facial port-wine stain and leptomeningeal angiomatosis

82
Q

Ocular manifestation of sarcoidosis

A

Anterior uveitis

-erythema around cornea, constricted pupil, blurred vision, moderate eye pain

83
Q

What age is considered delayed for children to walk

A

Walking normally occurs 9-16 months, consider eval if not walking by age 16

84
Q

Lead time bias vs. length time bias

A

Both problems w/ screening tests

Length-time bias = false increase in survival due to increased detection of less aggressive cases (slowly progressive) cases
ex: PSA found prostate cancers that wouldn’t have killed ppl anyway

Lead time bias- test diagnoses diseases earlier, so time from diagnosis from death appears prolonged despite no improvement in survival

85
Q

Hawthorne effect

A

= Observer effect

Alteration of behavior of subjects of a study due to their awareness of being observed

86
Q

MC clinical features of lead toxicity

A

Neuropsych- behavioral disturbances, cognitive impairment

Then very severe (lead levels over 100) can be assocaited w/ acute encephalopathy- seizures, AMS

87
Q

Symptoms of organophosphate poisoning

(b) Tx

A 
Organopshophate poisoning = Cholinergic toxicity = DUMBELS
Diarrhea
Urination
Miosis (pinpoint pupils)
Bradycardia
Emesis
Lacrimation
Sweaing

(b) Atropine = anticholinergic

88
Q

Mechanism of pyridostigmine

(b) Uses

A

Pyridostigmine = inhibits ACh breakdown

(b) Use in myasthenia gravis

89
Q

Baby born w/ Turner’s syndrome, why do they need

(a) TTE
(b) Renal ultrasound

A

Newborn w/ webbed neck

(a) TTE to r/o coarctation of aorta
- also BP measurements on all 4 extremities

(b) Renal ultrasound to screen for horseshoe kidney- increases risk of UTIs

90
Q

Explain the mechanism of hypophosphatemia in refeeding syndrome

A

Dextrose stimulates insulin secretion which drives phosphate into cells to be used for oxidative phosphorylation, rapidly depleting serum levels to make ATP

91
Q

Mechanism of TRALI

(b) What to watch out for in future transfusions?

A

TRALI = transfusion-related lung injury = form of ARDS from factor in the transfused blood that triggers recipient neutrophils to release inflammatory cytokines

(b) Recipient is not at increased risk of transfusion reactions in the future, it is more a component of the donor blood (so pt should not receive blood from that same donor again)

92
Q

ABPA

(a) 2 main risk factors
(b) Findings on chest imaging
(c) Lab abnormalities

A

Allergic bronchopulmonary aspergillus

(a) Asthmatics and cystic fibrosis- intense IgE and IgG mediated immune response after recurrent exacerbations
(b) Upper lobe opacities, bronchiectasis (bronchial wall thickening) on CT chest
(c) Eosinophilia (ex: 10% eos), +skin test for aspergillus

93
Q

ABPA

(a) Typical clinical manifestation
(b) Tx

A

Allergic bronchopulmonary aspergillus

(a) When pt w/ asthma or CF has recurrent exacerbations w/ fever, malaise, cough w/ brown sputum, symptoms of bronchial obstruction
(b) Steroids to reduce inflammation, then can consider antifungals but mainstay is steroids

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