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Uworld questions > uworld deck 2 > Flashcards

uworld deck 2 Flashcards

1
Q

What is indication of worsening CHF? How manage this finding?

A

get worsening hyponatremia due to increased free water retention. Can manage w/ diuretics.

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2
Q

What is cervical spondylosis?

A

Osteophyte induced radiculopathy w/ sensory deficit. Typically presents w/ chronic neck pain, limited neck rotation and lateral bending due to OA and muscle spasm.

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3
Q

What are xray findings w/ cervical spondylosis?

A

See osteophytes, narrowing of disk spaces, hypertrophic vertebral bodies.

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4
Q

How does autonomic dysfxn lead to syncope?

A

postural hypotension results, can dx w/ tilt test

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5
Q

What is concern for corticosteroid use w/ hip, thigh, groin pain.

A

Worried about steroid induced osteonecrosis (avascular necrosis) of the hip

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6
Q

How does femoral head necrosis px?

A

anterior hip pain worsened w/ activities & relieved by rest w/ progressive limitation. May have (-) xray findings. Requires MRI to dx.

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7
Q

Common causes of exertional syncope?

A

Vtach, LV outflow obstrxn (AS, HOCM),

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8
Q

How does aortic stenosis px?

A

syst. ejxn murmur @ R 2nd intercostal that radiates to carotids, get pulsus parves et tardes

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9
Q

When would capillary pulsations be visible?

A

See it with aortic regurg on lips and fingers

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10
Q

What is hepatorenal syndrome?

A

complication of ESLD, px w/ dcrsd GFR w/out other signs of renal dysfxn that fails to improve w/ fluid bolus. Likely 2/2 renal vasoconstrxn. Only corrected w/ liver xplant.

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11
Q

What is a hazard ratio?

A

Ratio of an event rate occuring in tx group comprd to event rate in nontx group.

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12
Q

How interpret hazard ratio?

A

If >1 then tx group had higher event rate, if <1 then control group had higher event rate.

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13
Q

Whas is susceptibility bias?

A

bias that patients in 1 group have worse outcomes 2/2 to their worse initial health status.

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14
Q

What is best initial test for cholelithiasis?

A

ab U/S is step 1

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15
Q

Who most likely to get hepatic adenoma?

A

young-middl age women w/ OCP use. Can also happen w/ androgen use, glycogen storage disease, prego, DM

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16
Q

How does hepatic ademona appear on biopsy? W/ labs?

A

enlarged adenoma cells containing glycogen and lipids w/ no regular architecture. Will see elevated GGT and alk phos.

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17
Q

How does FNH appear on biopsy?

A

sinusoids and kupfer cells present

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18
Q

What are si/sx of early alzheimers?

A

anterograde mem loss, visuospatial defects, language probs.

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19
Q

Late findings w/ late alzheimers?

A

Neuropsych problems - hallucinations, dyspraxia, lack of insight, incontinence

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20
Q

How does corticosteroid HPA axis suppression occur?

A

Get suppression of CRH and ACTH response to CRH. Leads to dcrsd adrenal steroid stim. Aldo typically remains nl.

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21
Q

What is prophyrea cutanea tarda?

A

Deficiency of uroporphryn decarb

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22
Q

How does porphyrea cutanea tarda px?

A

have painless blisters, incrsd skin fragility, facial hypertrichosis, hyperpigmentation.

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23
Q

How tx porphyrea cutanea tarda?

A

phlebotomy or hydroxychloroquine or interferon a if hep C positive

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24
Q

How dx cdiff infxn?

A

do stool toxin testing

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25
Q

How tx MS?

A

dx w/ MRI then start methylprednisolone. If failure to respond do plasma exchange

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26
Q

How does neurocysticerosis appear on radiog.

A

see multiple small fluid filled cysts, usually asx

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27
Q

What is initial tx for PE?

A

IV heparin, LMWH, Xa inhibitors (fundaparinux). Must use heparin if poor renal fxn, GFR < 30

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28
Q

How does angioedema px? Why does it occur?

A

edema of face, limbs, genitals, laryngeal edema, colicky ab pain. Due to C1 esterase deficiency, leads to incrsd C2b and bradykinin

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29
Q

How dx exudative effusion?

A

pleural fluid protein/serum protein > 0.5

fluid LDH/ serum LDH > 0.6

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30
Q

how dx lumbar spinal stenosis?

A

will have position dependent leg pain and back pain, pain worse w/ standing, walking due to extension of spine.

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31
Q

What is first step to eval pleural fluid?

A

Need to tap it w/ thoracentesis to characterize.

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32
Q

How does anterior cerebral artery stroke px?

A

contralateral LE motor +/or sensory deficit. May also have urinary incontinence gait apraxia, primitive reflexes.

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33
Q

What is best anti-nausea agent w/ chemo?

A

serotonin antagoinst - ondansetron (zofran)

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34
Q

What is cytochemical finding w/ hairy cell leukemia?

A

presence of tartrate resistant acid phosphatase & tx w/ cladribine.

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35
Q

What is tx for NHL?

A

CHOP, if CD20+ at rituximab

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36
Q

Most common STD?

A

chlamydia (intracellular pathogen), commonly coinfected w/ N/ Gonorrhea

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37
Q

How does chlamydia px?

A

women esp asx, some men asx, px w/ dysuria, purulent urethral d/c, scrotal pain, fvr in men, purulent urethral d/c in women, intermenstrual bleeding, dysuria

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38
Q

Complications of chlamydia in women?

A

PID, salpingitis, ectopic pregnancy, infertility, TOA

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39
Q

How tx chlamydia?

A

use azithromycin (1 dose PO) or doxy (PO x 7 days), tx w/ 1 dose rocephin as commonly coinfected w/ gonorrhea.

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40
Q

How does gonorrhea px?

A

asx in women, sx in men, commonly coinfected w/ chlamydia. Can infect pharynx, conjunctiva, and rectum.

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41
Q

How dx gonorrhea?

A

gram stain of urethral d/c showing organisms w/in leukocytes. Can tx empirically w/out cx.

42
Q

How does disseminated gonorrhea px?

A

fvr, arthralgia, tenosynovitis, migratory polyarthritis/ septic arthritis, endocarditis, rash

43
Q

What immunity is weakened in HIV?

A

cellular immunity (humoral B cell immunity relatively nl).

44
Q

What are si/sx of primary HIV infxn?

A

mono like sx 2-4 wks after exposure, may be asx, also fvr, sweats, malaise, lethargy, HA, arthralgia, myalgia, diarrhea, maculopapular rash

45
Q

What are sx of HIV infxn (pre-AIDs)?

A

persistent LAD, localized fungal infxn, oral hairy leukoplakia

46
Q

What is purpose of CD4 count?

A

Determine risk of opportunistic infxn.

47
Q

What is purpose of PCR viral count

A

determine efficacy of current tx

48
Q

How is AIDS defined?

A

CD4<200 w/ opportunistic infxns/ malignancy

49
Q

Most common cause of death in HIV/AIDS

A

PCP infxn, occurs when CD4 count <=200, px w/ fvr, nonproductive cough, SHOB

50
Q

How does toxo px on MRI/CT

A

contrast - enhanced mass lesion in basal ganglia or subcortical white matter

51
Q

What is most common opportunistic infxn in AIDS patient?

A

MAC infxn, leads to wasting syndrome, LAD, anemia. occurs w/ CD4<50

52
Q

How tx HIV?

A

HAART therapy - 2 NRTIs & 1 NNRTI or protease inhibit

53
Q

How tx PCP HIV?

A

tx w/ suladyazine pyrimethamine or bactrim x 3 weeks and prevent w/ bactrim

54
Q

What vaccines needed in HIV?

A

need pneumovax q5yrs, flu qyear, hep B if not already immune

55
Q

What STDs cause painless genital ulcers?

A

syphillus, lymphogranuloma venereum, granuloma inguinale

56
Q

What STDs cause painful genital ulcers?

A

HSV, chancroid

57
Q

Of painless ulcers, which have LAD?

A

Lymphogranuloma venereum, painful indurated LAD, syphillis px w/ painless LAD

58
Q

What are sx of HSV1?

A

primary infxn usualyl asx, can have fvr, malaise, oral lesion. Can px w/ bell’s palsy

59
Q

What are si/sx of hSV 2?

A

can have svr prolonged sx x 3 weeks w/ fvr, malaise, painful genital vesicles/pustules

60
Q

How does disseminated HSV px?

A

can result in meningitis, encephalitis, keratinitis

61
Q

How dx HSV?

A

tzack smear from open sore, get multinucleated giant cells, can also culture or do ELISA

62
Q

How does syphillis px?

A

initiall get chancre- hard indurated painless ulcer

63
Q

How does 2* syphillis px?

A

maculopapular rash most often (including on palm/soles), also flu-like illness, aseptic meningitis, hepatitis

64
Q

What bug causes chancroid? How tx?

A

Haemophilus ducreyi- G (-) rod. Tx w/ azithro, ceftri IM x1

65
Q

What causes lymphogranuloma venereum?

A

Chlamydia trachomatis

66
Q

How does lymphogranuloma venereum px?

A

painless ulcer w/ painful fluctuant LAD, also proctocolitis w/ perianal fissures and rectal strictures can occur.

67
Q

How tx lymphogranuloma venereum px?

A

tx w. doxy PO x 21 days

68
Q

Px of parkinson’s disease?

A

masked facies, hypokinetic gait, resting tremor, rigidity, parkinsonian gait

69
Q

What drugs cause ototoxicity?

A

loop diuretics, aminoglycosides ABX, chemo agents, aspirin, incrsd risk w/ higher doses of loops or w/ renal disease

70
Q

Side effects of ACE inhibitor?

A

cough, hyperkalemia, angioedema

71
Q

How manage si/sx of lyme disease?

A

if early stage, begin empirice doxy, serology negative in many pts early on, Tx w/ ampicillin for kids <8 or if prego

72
Q

If hemolytic episodes following oxidative insult?

A

likely G6pd even if levels of G6PD are nml. May be moderate deficiency & only nml cells in remain after hemolysis

73
Q

Si/sx of CREST?

A

calcinosis cutis, raynouds, esophagela dysmotility, sclerodactyly, telangiectasia

74
Q

How does neuroapthy px in DM pts?

A

symmetric distal polyneuropathy, stocking and glove pattern

75
Q

Si/sx of diabetic autoimmune neuropathy?

A

gastroparesis, enteropathy, postural hypotension, abnormal sweating, cystopathy, ED

76
Q

CML cytogenitc fx?

A

9:22 xlocation leading to BCR-ABL fusion protein, tx w/ tyrosine kinase inhibitor gleevec

77
Q

How mnage invasive mucormycosis?

A

surgical debridement and amphotericin

78
Q

How does subacromian bursitis px?

A

pain w/ active ROM, tenderness in shoulder w/ internal rotation and forward flexion

79
Q

How mange <3 cm pulmo nodule?

A

get old cxr if available, if unchanged observe. CXR repeat q3m, if same size over 12 months then no further w/u. If high risk pt (smoker), get CT

80
Q

Cuase of chronic primary adrenal insufficiency w/ cavitary lesion in lung?

A

Likely TB adrenalitis - px w/ fatigue, weakness, borderline hypotension, electrolyte problems. Get hyponatremic, hyperkalemic, hyperCa

81
Q

Si/sx of methanol intox?

A

HA,N/V, epigastric pain all usually 24 hrs after ingeston, vision loss + coma, optic disc hyperemia. No kidney damage

82
Q

SI/sx aspirin OD?

A

anion gap metabolic acidosis, tinnitus, fvr, hyperventilation — respiratory alkalosis

83
Q

Which is strongest risk fx for stroke?

A

htn is greatest, stronger than DM and smoking

84
Q

Biopsy sign of IBD?

A

will have neutrophillic cryptitis on bx, ix xmural then crohns, if mucosal then UC

85
Q

What is appearence of atypical lymphocyte?

A

convoluted nuclei and highly vacuolated cytoplasm

86
Q

Si/sx of infectious mono?

A

fatigue, malaise, sore throat, rash, posterior cervical LAD, maculopurpuric rash, palatal petechiae, splenomeg,

87
Q

How dx infectious mono?

A

Heterophile Ab is ideal test but may be negative for first week following sx

88
Q

What is TB?

A

acid fast BACILLI

89
Q

Si/sx of PSGN?

A

RBC’s in urine, proteinuria (+1), RBC casts, low C3, periorbital swelling

90
Q

How fast should hyponatremia be fixed?

A

not more than 0.5 meq/L/hr

91
Q

WHat is mutation in wilson’s diseae?

A

AR disease in ceruloplasmin prodxn and secretion

92
Q

How tx WIlson’s disease?

A

copper chelators (penicillamine and tirentine) plus oral zinc to prevent Cu gut absorption.

93
Q

Diagnostic criteria for Lynch?

A

> or = 3 relatives w/ colorectal cancer w/ 1 first degree relative. > or = 2 generations involved w/ 1 case dx bfr 50, FAP excluded

94
Q

What is cause of niacin flushing?

A

due to prostacyclin mediated vasodilation. histamine also involved but NOT hypersensitivity rxn

95
Q

What is pronator drift?

A

turning inward and downward of palm w/ eyes closed. Specific for upper motor neuron lesion.

96
Q

How assess cerebellar fxn?

A

assess for dysmetria w/ rapid alternating movements

97
Q

Si/sx of acute angle glaucoma?

A

occurs 2/2 pupillary dilation — constrxn of anterior chamber, px w/ rapid onset of svr pain + vision loss, halos of light, red eye, lacrimation, N/V

98
Q

Metabolic abnormalities assoc w/ hypothyroidism

A

HLD, hypoNa, incrsd CK, incrsd LFTs, HLD mainly due to dcrsd LDL receptors +/- dcrsd LDL receptor activity

99
Q

When screen for lipid disorders?

A

men > 35 y/o & women > 45 y/o, begin at 20 if have DM, fmhx of premature cardiac death, familial HLD, other risk fx

100
Q

How tx restless leg syndrome?

A

Fe replacement if ferritin < 75, dopamine agonist otherwise (pramipaxole, ropinorole)

Uworld questions (13 decks)

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