uworld deck 2 Flashcards
What is indication of worsening CHF? How manage this finding?
get worsening hyponatremia due to increased free water retention. Can manage w/ diuretics.
What is cervical spondylosis?
Osteophyte induced radiculopathy w/ sensory deficit. Typically presents w/ chronic neck pain, limited neck rotation and lateral bending due to OA and muscle spasm.
What are xray findings w/ cervical spondylosis?
See osteophytes, narrowing of disk spaces, hypertrophic vertebral bodies.
How does autonomic dysfxn lead to syncope?
postural hypotension results, can dx w/ tilt test
What is concern for corticosteroid use w/ hip, thigh, groin pain.
Worried about steroid induced osteonecrosis (avascular necrosis) of the hip
How does femoral head necrosis px?
anterior hip pain worsened w/ activities & relieved by rest w/ progressive limitation. May have (-) xray findings. Requires MRI to dx.
Common causes of exertional syncope?
Vtach, LV outflow obstrxn (AS, HOCM),
How does aortic stenosis px?
syst. ejxn murmur @ R 2nd intercostal that radiates to carotids, get pulsus parves et tardes
When would capillary pulsations be visible?
See it with aortic regurg on lips and fingers
What is hepatorenal syndrome?
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.
What is a hazard ratio?
Ratio of an event rate occuring in tx group comprd to event rate in nontx group.
How interpret hazard ratio?
If >1 then tx group had higher event rate, if <1 then control group had higher event rate.
Whas is susceptibility bias?
bias that patients in 1 group have worse outcomes 2/2 to their worse initial health status.
What is best initial test for cholelithiasis?
ab U/S is step 1
Who most likely to get hepatic adenoma?
young-middl age women w/ OCP use. Can also happen w/ androgen use, glycogen storage disease, prego, DM
How does hepatic ademona appear on biopsy? W/ labs?
enlarged adenoma cells containing glycogen and lipids w/ no regular architecture. Will see elevated GGT and alk phos.
How does FNH appear on biopsy?
sinusoids and kupfer cells present
What are si/sx of early alzheimers?
anterograde mem loss, visuospatial defects, language probs.
Late findings w/ late alzheimers?
Neuropsych problems - hallucinations, dyspraxia, lack of insight, incontinence
How does corticosteroid HPA axis suppression occur?
Get suppression of CRH and ACTH response to CRH. Leads to dcrsd adrenal steroid stim. Aldo typically remains nl.
What is prophyrea cutanea tarda?
Deficiency of uroporphryn decarb
How does porphyrea cutanea tarda px?
have painless blisters, incrsd skin fragility, facial hypertrichosis, hyperpigmentation.
How tx porphyrea cutanea tarda?
phlebotomy or hydroxychloroquine or interferon a if hep C positive
How dx cdiff infxn?
do stool toxin testing
How tx MS?
dx w/ MRI then start methylprednisolone. If failure to respond do plasma exchange
How does neurocysticerosis appear on radiog.
see multiple small fluid filled cysts, usually asx
What is initial tx for PE?
IV heparin, LMWH, Xa inhibitors (fundaparinux). Must use heparin if poor renal fxn, GFR < 30
How does angioedema px? Why does it occur?
edema of face, limbs, genitals, laryngeal edema, colicky ab pain. Due to C1 esterase deficiency, leads to incrsd C2b and bradykinin
How dx exudative effusion?
pleural fluid protein/serum protein > 0.5
fluid LDH/ serum LDH > 0.6
how dx lumbar spinal stenosis?
will have position dependent leg pain and back pain, pain worse w/ standing, walking due to extension of spine.
What is first step to eval pleural fluid?
Need to tap it w/ thoracentesis to characterize.
How does anterior cerebral artery stroke px?
contralateral LE motor +/or sensory deficit. May also have urinary incontinence gait apraxia, primitive reflexes.
What is best anti-nausea agent w/ chemo?
serotonin antagoinst - ondansetron (zofran)
What is cytochemical finding w/ hairy cell leukemia?
presence of tartrate resistant acid phosphatase & tx w/ cladribine.
What is tx for NHL?
CHOP, if CD20+ at rituximab
Most common STD?
chlamydia (intracellular pathogen), commonly coinfected w/ N/ Gonorrhea
How does chlamydia px?
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
Complications of chlamydia in women?
PID, salpingitis, ectopic pregnancy, infertility, TOA
How tx chlamydia?
use azithromycin (1 dose PO) or doxy (PO x 7 days), tx w/ 1 dose rocephin as commonly coinfected w/ gonorrhea.
How does gonorrhea px?
asx in women, sx in men, commonly coinfected w/ chlamydia. Can infect pharynx, conjunctiva, and rectum.
How dx gonorrhea?
gram stain of urethral d/c showing organisms w/in leukocytes. Can tx empirically w/out cx.
How does disseminated gonorrhea px?
fvr, arthralgia, tenosynovitis, migratory polyarthritis/ septic arthritis, endocarditis, rash
What immunity is weakened in HIV?
cellular immunity (humoral B cell immunity relatively nl).
What are si/sx of primary HIV infxn?
mono like sx 2-4 wks after exposure, may be asx, also fvr, sweats, malaise, lethargy, HA, arthralgia, myalgia, diarrhea, maculopapular rash
What are sx of HIV infxn (pre-AIDs)?
persistent LAD, localized fungal infxn, oral hairy leukoplakia
What is purpose of CD4 count?
Determine risk of opportunistic infxn.
What is purpose of PCR viral count
determine efficacy of current tx
How is AIDS defined?
CD4<200 w/ opportunistic infxns/ malignancy
Most common cause of death in HIV/AIDS
PCP infxn, occurs when CD4 count <=200, px w/ fvr, nonproductive cough, SHOB
How does toxo px on MRI/CT
contrast - enhanced mass lesion in basal ganglia or subcortical white matter
What is most common opportunistic infxn in AIDS patient?
MAC infxn, leads to wasting syndrome, LAD, anemia. occurs w/ CD4<50
How tx HIV?
HAART therapy - 2 NRTIs & 1 NNRTI or protease inhibit
How tx PCP HIV?
tx w/ suladyazine pyrimethamine or bactrim x 3 weeks and prevent w/ bactrim
What vaccines needed in HIV?
need pneumovax q5yrs, flu qyear, hep B if not already immune
What STDs cause painless genital ulcers?
syphillus, lymphogranuloma venereum, granuloma inguinale
What STDs cause painful genital ulcers?
HSV, chancroid
Of painless ulcers, which have LAD?
Lymphogranuloma venereum, painful indurated LAD, syphillis px w/ painless LAD
What are sx of HSV1?
primary infxn usualyl asx, can have fvr, malaise, oral lesion. Can px w/ bell’s palsy
What are si/sx of hSV 2?
can have svr prolonged sx x 3 weeks w/ fvr, malaise, painful genital vesicles/pustules
How does disseminated HSV px?
can result in meningitis, encephalitis, keratinitis
How dx HSV?
tzack smear from open sore, get multinucleated giant cells, can also culture or do ELISA
How does syphillis px?
initiall get chancre- hard indurated painless ulcer
How does 2* syphillis px?
maculopapular rash most often (including on palm/soles), also flu-like illness, aseptic meningitis, hepatitis
What bug causes chancroid? How tx?
Haemophilus ducreyi- G (-) rod. Tx w/ azithro, ceftri IM x1
What causes lymphogranuloma venereum?
Chlamydia trachomatis
How does lymphogranuloma venereum px?
painless ulcer w/ painful fluctuant LAD, also proctocolitis w/ perianal fissures and rectal strictures can occur.
How tx lymphogranuloma venereum px?
tx w. doxy PO x 21 days
Px of parkinson’s disease?
masked facies, hypokinetic gait, resting tremor, rigidity, parkinsonian gait
What drugs cause ototoxicity?
loop diuretics, aminoglycosides ABX, chemo agents, aspirin, incrsd risk w/ higher doses of loops or w/ renal disease
Side effects of ACE inhibitor?
cough, hyperkalemia, angioedema
How manage si/sx of lyme disease?
if early stage, begin empirice doxy, serology negative in many pts early on, Tx w/ ampicillin for kids <8 or if prego
If hemolytic episodes following oxidative insult?
likely G6pd even if levels of G6PD are nml. May be moderate deficiency & only nml cells in remain after hemolysis
Si/sx of CREST?
calcinosis cutis, raynouds, esophagela dysmotility, sclerodactyly, telangiectasia
How does neuroapthy px in DM pts?
symmetric distal polyneuropathy, stocking and glove pattern
Si/sx of diabetic autoimmune neuropathy?
gastroparesis, enteropathy, postural hypotension, abnormal sweating, cystopathy, ED
CML cytogenitc fx?
9:22 xlocation leading to BCR-ABL fusion protein, tx w/ tyrosine kinase inhibitor gleevec
How mnage invasive mucormycosis?
surgical debridement and amphotericin
How does subacromian bursitis px?
pain w/ active ROM, tenderness in shoulder w/ internal rotation and forward flexion
How mange <3 cm pulmo nodule?
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
Cuase of chronic primary adrenal insufficiency w/ cavitary lesion in lung?
Likely TB adrenalitis - px w/ fatigue, weakness, borderline hypotension, electrolyte problems. Get hyponatremic, hyperkalemic, hyperCa
Si/sx of methanol intox?
HA,N/V, epigastric pain all usually 24 hrs after ingeston, vision loss + coma, optic disc hyperemia. No kidney damage
SI/sx aspirin OD?
anion gap metabolic acidosis, tinnitus, fvr, hyperventilation — respiratory alkalosis
Which is strongest risk fx for stroke?
htn is greatest, stronger than DM and smoking
Biopsy sign of IBD?
will have neutrophillic cryptitis on bx, ix xmural then crohns, if mucosal then UC
What is appearence of atypical lymphocyte?
convoluted nuclei and highly vacuolated cytoplasm
Si/sx of infectious mono?
fatigue, malaise, sore throat, rash, posterior cervical LAD, maculopurpuric rash, palatal petechiae, splenomeg,
How dx infectious mono?
Heterophile Ab is ideal test but may be negative for first week following sx
What is TB?
acid fast BACILLI
Si/sx of PSGN?
RBC’s in urine, proteinuria (+1), RBC casts, low C3, periorbital swelling
How fast should hyponatremia be fixed?
not more than 0.5 meq/L/hr
WHat is mutation in wilson’s diseae?
AR disease in ceruloplasmin prodxn and secretion
How tx WIlson’s disease?
copper chelators (penicillamine and tirentine) plus oral zinc to prevent Cu gut absorption.
Diagnostic criteria for Lynch?
> or = 3 relatives w/ colorectal cancer w/ 1 first degree relative. > or = 2 generations involved w/ 1 case dx bfr 50, FAP excluded
What is cause of niacin flushing?
due to prostacyclin mediated vasodilation. histamine also involved but NOT hypersensitivity rxn
What is pronator drift?
turning inward and downward of palm w/ eyes closed. Specific for upper motor neuron lesion.
How assess cerebellar fxn?
assess for dysmetria w/ rapid alternating movements
Si/sx of acute angle glaucoma?
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
Metabolic abnormalities assoc w/ hypothyroidism
HLD, hypoNa, incrsd CK, incrsd LFTs, HLD mainly due to dcrsd LDL receptors +/- dcrsd LDL receptor activity
When screen for lipid disorders?
men > 35 y/o & women > 45 y/o, begin at 20 if have DM, fmhx of premature cardiac death, familial HLD, other risk fx
How tx restless leg syndrome?
Fe replacement if ferritin < 75, dopamine agonist otherwise (pramipaxole, ropinorole)
