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Uworld questions > uworld dec 3 > Flashcards

uworld dec 3 Flashcards

1
Q

What are most common bugs in cellulitis?

A

Grp A strep and S. Aurea, also can have C. Perfringens

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2
Q

What is usual cause of cellulitis?

A

IV catheters, incision, bites/wounds. Also can happen w/ venous stasis, lymphedema, DB ulcer

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3
Q

What is erysipelas?

A

Cellulitis confined to dermis & lymphatics. Usuall due to GAS.

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4
Q

What bug causes tetanus and how tx?

A

Clostridium tetani, G+ anaerobic tetani, tx with

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5
Q

What is osteomyelitis usually due to ?

A

S. aureus if catheter septicemia, coag - staph if prosthetic joint, salmonella in sickle cell

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6
Q

What are risks for osteomyelitis?

A

open fx, DM, IV drug use, sepsis

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7
Q

How use ESR & CRP w/ osteomyelitis

A

Used to trend tx effectiveness w/ cellulitis and other infxns

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8
Q

Best imaging study for osteomyelitis?

A

MRI is best for dx & assesing extent of disease

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9
Q

How tx osteomyelitis?

A

requires long term IV ABX with ABX used based cx. may require surgical debridement if significant bone involvement.

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10
Q

How easily r/o septic arthritis?

A

If painless ROM, then septic arthritis highly unlikely.

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11
Q

How get acute septic arthritis?

A

most often w/ hematogenous spread, can occur w/ contiguous spread as well from abscess etc.

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12
Q

Most common bugs of septic arthritis?

A

s. aureus most common, also strep. If young think N. gonorrhea,

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13
Q

Signs of septic arthritis of joint aspirate?

A

WBC>50k, mostly segs, no crystals

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14
Q

How tx septic arthritis?

A

tx immediately w/ empiric ABX, vanc or other staph ABX, consider surgical drainage

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15
Q

How does stg 1 of lyme disease px?

A

eryhtema migrans-> tx w/ dox

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16
Q

What causes hypertrophic cardiomyopathy?

A

usually px in younger pts, due to assym septal hypertrophy causing outflow obstrxn

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17
Q

What causes concentric hypertrophy of the heart?

A

constant pressure overload such as in AS or uncontrolled HTN, (eccentric hypertrophy does not cause CHF)

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18
Q

Best way to dx rotator cuff tear?

A

MRI of shoulder

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19
Q

What is case control study?

A

takes groups of disease patients and group of healthy pts, looks back @ freq of particular risk fx in the 2 groups. Looks at outcomes first, then risk fx

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20
Q

What is retrospective cohort study?

A

reviews records, looks @ positive risk fx and negative risk fx and determines who gets sick. (e.g. those who smoke vs those who didnt in cancer pts)

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21
Q

What is a cross-sectional study?

A

Looks at exposure and outcome at the same time, cannot establish causation. determines rate of illness in 2 groups.

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22
Q

What causes intraparenchymal hemmorrhage?

A

uncontrolled htn most commonly, leads to lacunar strokes in BG, putamen, thalamus, cerebellum. Rarely get lobar hemorrhages due to htn

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23
Q

How do putaminal strokes px?

A

get hemiplegia, hemisensory loss

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24
Q

first step in evaluation of solitary pulm nodule?

A

based on probability of having malignancy, if low risk- do serial CT scans, if interm risk & >1cm, do FDG-PET and surgical excision if positive, if <1cm do CT to further asses

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25
Q

Sx of open angle glaucoma?

A

loss of periph vision w/ cupping optic disc, tx w/ beta blocker drops -> timolol

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26
Q

Cause of lambet eaton syndrome?

A

Associated w/ small cell lung cancer, due to Ab against voltage gated Ca channels of muscle

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27
Q

Infxs causes of BLOODY diarrhea?

A

shigella, E.Coli, campylobacter

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28
Q

Signs of pulmo htn?

A

enlrgment of pulmo arteries w/ distal tapering on Cxr, enlarged Rvent, R axis deviation

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29
Q

Adv effects of antithyroid drugs?

A

methimazole is teratogen, causes cholestatic jaundice, PTU can cause vasculitis, both can cause arthralgia, hepatitis, agranulocytosis

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30
Q

Adv effects of radiation ablation for hyperthyroid tx?

A

Leads to permanent hypothyroidism, and worsening opthalmopathy

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31
Q

Why ptu usually avoided?

A

can cause svr liver injury leading to acute liver failure

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32
Q

How differntiate cushing disease & ectopic ACTH prodxn?

A

w/ incrsd ACTH and incrsd cortisol, if high dose dexa fails to suppress, then ectopic, if high does does suppress then cushing disease (ACTH producing pit adenoma)

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33
Q

Other si/sx of ectopic ACTH prodxn?

A

rapidly develops usually, hypokalemic alkalosis, pigmentation, htn, lack of florid cushing syndrome features since so rapid

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34
Q

What can cause ectopic ACTH prodxn?

A

small cell lung cancer, pancreatic cancer, neuroendo tumors, bronchogenic carcinoma

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35
Q

What are si/sx of carboxyhbg?

A

polycythemia, dizziness, HA, nausea

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36
Q

How tx dermatitis herpetiformis?

A

Gluten free diet and dapsone if refractory

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37
Q

How manage CR cancer screening in UC pts?

A

Begin colonoscopies 8 yrs after dx, do annually w/ multiple biopsies each time, do prophylactic total proctocolectomy when dysplasia discovered

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38
Q

Sx of hypokalemia?

A

weakness, fatigue, muscle cramps, flaccid paralysis, hyperreflexia, rhabdo, arryth

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39
Q

ECG findings w/ hypoK

A

broad flat T waves, u waves, ST depression + pvcs

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40
Q

Common cause of hypoK?

A

diarrhea, vomiting, anorexia, hypoaldosteronism

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41
Q

Si/sx of ALS?

A

degen motor neuron disease affecting upper and lower motor neurons = hyperreflexia, spasticity, fasciculations -> no tenderness or muscle pain

42
Q

How determine rhabdo on lab?

A

Incrsd CK, lrg amt of blood on dipstick but no RBCs under micro, myoglobinuria

43
Q

Incrsd risk of infxn w/ alpha antitrypsin deficiency?

A

NOPE

44
Q

What are 2 most common inflamm myopathies? Si/Sx

A

polymyositis + dermatomyositis, px w/ incrsd ESR, CK, and prox muscle weakness, tx w/ corticosteroids

45
Q

Tx for myasthenia gravis?

A

pyridiostigmine (anticholineterase)

46
Q

Cause of dermatomyositis & polymositis?

A

humoral immune mechanisms in dermato, cell-mediated for polymyositis

47
Q

Si/sx of myositis?

A

Symmetric prox muscle weakness, myalgia, dysphagia in some patients

48
Q

Unique sx of dermatomyositis?

A

heliotrope rash, gouttrons papules, (MCP, PIP,DIP), shawl sign. periungal erythema, incrsd risk of cancer in lung, breast, ovary, GI tract w/ dermato

49
Q

Other causes of myopathy?

A

hypothyroidism, thyrotoxicosis, cushing syndrome, electrolytes abnormalities (dcrsd K, Ca, PO4), drugs (steroids, zidovudine, colchicine)

50
Q

Si/sx of hypothyroidism?

A

fatigue, prox muscle weakness, sluggish ankle reflexes, nml ESR, incrsd CK

51
Q

How tx goodpastures syndrome?

A

removal of circulating anti-glomerular basement membrane Ab via emergent plasmapheresis.

52
Q

Goodpastures px w/?

A

hemoptysis, dyspnea, ankle edema, hematuria, UA shows dysmorphic RBCs, mod proteinuria, red cell casts

53
Q

How tx wegeners?

A

cyclophosphamide + steroids

54
Q

What is AERD?

A

aspirin exacerbated respiratory disease

55
Q

How does AERD px?

A

get wheezing following naproxen ingestion

56
Q

How manage infective endocarditis?

A

draw cx 1st, then begin empiric ABX, then do imaging studies.

57
Q

How manage acetominophen OD?

A

in first 2 hours, give activated charcoal, begin @ hr four, obtain serum levels and admin N-acetylcysteine. Do not give NAC if >8hrs since ingestion.

58
Q

Si/sx of hyperammonemia?

A

asterixis, irritability, inversion of sleep-wake cycle, confusion, disorientation, anorexia, coma

59
Q

Si/sx of cobalamin deficieny?

A

dcrs position, vibratory sense & gait abnormalities

60
Q

How prevent recurrent Ca renal calculi?

A

dcrs protein intake and oxalate intake, restrict Na intake

61
Q

What immune fxn is impaired in post-splenectomy patients?

A

impaired phagocytosis due to failure of activate B cells, get no Ab prodxn leading to lack of phagocytosis

62
Q

Causes of defective cell-mediated immunity?

A

thymic aplasia for one

63
Q

Best initial tx following ischemic stroke?

A

give aspirin, if w/in 3-4.5 hrs give alteplase, use clopidogrel if cant tolerate or tried and failed aspirin therapy. DONT USE HEPARIN

64
Q

What is d-xylose test?

A

Absorbed w/out any digestion so only requires small bowel mucosa, determines absorptive capacity of small intestines. Suggests presence of malabsor dx like celiac.

65
Q

Si/sx of b12 deficiency?

A

macrocytic anemia, glossitis, periph neuropathy

66
Q

What is ranolazine?

A

late sodium channel blocker used in stable angina w/ sx at max therapy

67
Q

What is doxazosin? When contraindicated

A

alpha blocker. Only give 4 hours before/ after taking sildenafil

68
Q

What are categories of alkalosis?

A

chloride sensitive and chloride resistant

69
Q

What is Cl sensitive alkalosis?

A

hypochloremic alkalosis will respond to saline, chloride low in this case

70
Q

What is Cl resistance alkalosis?

A

normochloremic alkalosis that will not respond to saline infusion

71
Q

What is baker’s cyst?

A

tender mass in popliteal fossa assoc w/ RA. Due to excessive fluid collection in inflamed synovium. Also occurs in OA and cartilage tear

72
Q

Si/sx of hypertrophic cardiomyopathy?

A

epsodes of syncope, systolic murmur @ left sternal border, family hx of early HD

73
Q

tx for familial hypertrophic cardiomyopathy?

A

beta blockers -> have anti-anginal effect

74
Q

Si/sx of acute pancreatitis?

A

epigastric pain partially improved w/ sitting up, leaning forward, N/V

75
Q

How tx vtach?

A

if stable- amiodarone, lidocaine, procainamide. If unstable, synchronized cardioversion

76
Q

Who at risk for asbestosis?

A

hx of mining, shipbuilding, insulaters, pipe workers

77
Q

What are si/sx of asbestosis?

A

dyspnea, end inspiratory crackles, clubbing, incrsd risk of bronchogenic carcinoma and mesothelioma

78
Q

Rheumatoid Arthritis and boney problems?

A

incrsd risk of osteopenia and osteoporosis

79
Q

When use tetanus immune globulin?

A

only in pts who have not received complete series of tetanus immunization.

80
Q

Who doesnt need tetanus booster?

A

Omitted in pts who received booster w/in last 5 years, in pts w/ clean minor wounds who recevied vaccination w/in past 10 years.

81
Q

Who most likely to get vtach?

A

those w/ advanced systolic HF & underlying ischemic HD

82
Q

What is definition of orthostatic hypotension?

A

systolic bp decrease of 20 or more or diastolic dcrs of 10 or more.

83
Q

What meds commonly cause orthostatic hypotension?

A

alpha blockers, nitrates, ED meds, and antidepressants

84
Q

Other causes of orthostatic hypotension?

A

neurogenic (diabetes/ alcoholic neuropathy), MS, multiple system atrophy

85
Q

How does vasovagal syncope px?

A

commonly w/ prolonged standing w. prodrome of nausea, lightheadedness, diaphoresis, may have brief myoclonic jerks after losing conciousness

86
Q

What is sign of syncope due to heart block?

A

forehead bruise is classic sign because of sudden loss of conciousness & lack of preceding sx resulting in pt falling and injuring himself

87
Q

Best way to evaluate recurrent syncope?

A

Place implantable loop recorder if recurrent/ infrequent events

88
Q

Best way to tx depression after failure?

A

switch to another drug first, can be within same class

89
Q

When medically tx depression 2/2 to death?

A

if 2 consecutive wks of sx 8+ weeks after death

90
Q

Clinical findings of cocaine intox?

A

tachy, htn, hyperthermia, mydriasis, agitation, psychosis

91
Q

what is 1st line tx for cocaine intox?

A

sedation w/ lorazepam. Controls agitation = usually dcrses HR, BP, temp.

92
Q

Best way to treat alcohol dependence?

A

use naltrexone which has been shown to dcrs frequency of relapse

93
Q

How manage lumbar stenosis?

A

Manage non-surgically for 3 mo-2 yrs, failure of tx is considered when sx progression occurs w/ neuro deficits and svr pain.

94
Q

Si/Sx of vertebral osteomyelitis?

A

localized back pain, tender to palp, hx of IV drug use, fvr, incrsd ESR

95
Q

management of spinal osteomyelitis?

A

urgent spinal MRI followed by ABX + surgical debridement if necessary

96
Q

Si/sx of spinal cord compression?

A

spinal or radicular pain that may precede onset of neuro sx, weakness, numbness, sphincter disturbance

97
Q

what are most ommon causes of chronic cough?

A

asthma, post nasal drip, GERD

98
Q

How manage cough variant asthma?

A

trial of inhaled albuterol, if fails likely eosinophillic bronchitis, confirm dx w. BAL and biopsy

99
Q

most common cause of hemoptysis in outpatient?

A

infxn or malignancy

100
Q

How manage pt w. hemoptysis?

A

get cxr, then CT &/or bronchoscopy.

Uworld questions (13 decks)

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