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Uworld questions > uworld deck 4 > Flashcards

uworld deck 4 Flashcards

1
Q

What are most common bugs w/ cellulitis?

A

Grp A strep, S. Aureus

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2
Q

Causes of cellulitis?

A

IV catheters, incisions, bites/wounds, also venous stasis, lymphedema, Diabetic ulcer

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3
Q

What is erysipelas?

A

ceullulitis confined to dermis and lymphatics, usually 2/2 GAS

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4
Q

How tx tetanus?

A

Admit to ICU, consider intubation, metronidazole or other ABX, Tetanus immune globulin, benzos for symptomatic tx

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5
Q

What bugs usually cause osteomyelitis?

A

S. aureus if catheter septicemia, coag - staph if prosthetic jonit, salmonella if 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 of ESR and CRP in osteomyelitis?

A

Used only to trend tx effectiveness

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8
Q

Best studies for osteomyelitis?

A

Do MRI for dx and asses extent of disease, if cant do MRI, then do bone scan

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9
Q

How tx osteomyelitis?

A

Requires long term IV ABX (4-6 wks), based on cx, may require surgical debridement or amputation

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10
Q

What finding would r/o septic arthritis?

A

if painless ROM then septic arth unlikely

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11
Q

How get acute septic arthritis?

A

usually 2/2 hematog spread, can be direct spread from abscess

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12
Q

What are most common bugs for septic arthritis?

A

S. aureus most common, can also be strep. N. gonorrhea in young, Salmonella in sickle cell

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13
Q

Signs of septic arthritis on joint aspiration?

A

WBC>50,000, mostly segs, no crystals

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14
Q

How tx septic arthritis?

A

tx immediately with empiric ABX, vanc, G- coverage if concern for infxn of that type.

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15
Q

How does stage 1 of lyme disease px?

A

erythema migrans - lrg target shaped lesions, if more than 1 lesion then hematog spread present

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16
Q

How does stage 2 of lyme disease px?

A

early dissemination - HA, neck stiffness, Fvr/chills, fatigue. Late dissemin- encephalitis, meningitis, bilateral facial nerve palsy, AV block, pericarditis,

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17
Q

How tx lyme disease?

A

Tx w/ doxycycline, if allergic use amoxicillin or cefuroxime

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18
Q

What bug causes rockey mountain spotted fever?

A

rickettsiea ricketsiae an intracellular bacteria

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19
Q

What bug causes malaria?

A

plasmodium - vivax, ovale, falciparum, malariae

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20
Q

What is fvr pattern w/ malariae?

A

If falciparum, no pattern, if vivax/ovale 48 hr fvr ycle, malariae has 72 hr pattern

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21
Q

How dx malariae?

A

do giemsa stain of periph smear

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22
Q

How tx malaria?

A

If sensitive- chloroquine, if resistant then quinine and tetracycline or atovaquone-proguanil and mefloquine

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23
Q

What is rabies?

A

Viral encephalitis w/ pain @ bite, sore throat, fatigue, HA, N/V.

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24
Q

How does rabies encephalitis px?

A

confusion, combativeness, hyperactivity, fvr, seizures, hydrophobia

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25
Q

What are the types of aspergillus infxns?

A

allergic bronchopulmonary aspergillosis, pulmonary aspergilloma, invasive aspergillosis

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26
Q

What is ABPA?

A

type 1 hypersensitivity rxn that px w/ asthma and eosinophillia

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27
Q

What is pulmonary aspergilloma?

A

inhalation of spores in pts w/ hx of sarcoid, histo, TB, bronchiectasis

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28
Q

What is invasive aspergillosis?

A

hyphae invade lung leading to thrombosis and infxn. Mainly in AIDS patients

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29
Q

What is result of ascares infxn?

A

Can be asx, postprandial abd pain, vomiting, can get bowel, pancreatic, common bile duct obstrxn

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30
Q

How does diverticulitis px?

A

crampy ab pain, usually LLQ, w/ change in bowel habits

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31
Q

Best test for diverticulits?

A

best to do CT as is most sensitive & can detect complications like perfs and abscesses

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32
Q

Best test to asses concern for HUS?

A

need periph smear to look for schistocytes and incrsd retic

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33
Q

How manage HUS?

A

dont give ABX, platelet use is controversial as may worsen thrombosis

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34
Q

What is radiation proctitis?

A

Sx of diarrhea & tenesmus following radiation tx, px w/ mucosal telangiectasia and submucosal fibrosis on biopsy. Dx w/ flex sig

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35
Q

How manage salmonella gastroenteritis?

A

self limiting so only supportive care. Only tx aggressively if 50 y/o if have endovascular or bone prostehsis or if immunocomp

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36
Q

What are lab signs of hepatocellular injury?

A

Significant incrs in AST and ALT, ALT more specific to liver. Also see direct bili incrs and milk alk phos.

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37
Q

Effect of OCP on bile?

A

CAn get conj hyperbilirubinemia w/ incrs alk phos levels

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38
Q

How manage acute cholangitis?

A

Broad spec ABX w/ G+, G- and anaerobic coverage. Do ERCP to remove obstrxn

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39
Q

What level of TG necessary for pancreatitis?

A

TG must be >1000 for majority of cases

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40
Q

What should be done if evidence of pancreatic necrosis?

A

Tx w/ imipinem

41
Q

How manage gastric ulcers?

A

All gastric ulcers should be biopsied

42
Q

What are common causes of dyspepsia?

A

H. pylori and NSAIDS. If due to nsaids, tx by stopping tx

43
Q

Colonoscopic findings of ischemic colitis?

A

segmenal, hemorrhagic, nodules w/ linear or circumferential ulceration

44
Q

How manage pt following major upper GI bleed?

A

Need to do EGD to determine cause

45
Q

What screening necessary in pt w/ Hep B?

A

periodic liver U/S to determine HCC

46
Q

What antibody assoc w/ autoimmune hepatitis?

A

liver/kidney microsomal Ab, ANA, anti-smooth muscle Ab

47
Q

How asses cause of ascites?

A

determine SAAG, (Serum Alb - Ascitic Alb), if >1.1 then due to portal htn

48
Q

How manage hepatic encephalopathy?

A

start or increase dose of lactulose

49
Q

How does hepatic encephalopathy px?

A

reversal of sleep-wake cycle, mild mental status changes, progression to irritability, confusion, slurred speech

50
Q

What is hepatorenal failure?

A

devo of kidney failure in pts w/ portal htn & normal renal tubular fxn.

51
Q

What is erythema nodosum?

A

Small painful nodules on anterior tibia typically, common cutaneous prob w/ IBD. More common with crohns.

52
Q

What is microscopic colitis?

A

Chronic water diarrhea w/out bleeding, can be collagenous type or lymphocytic type. Tx w/ loperamide diphenoxylate, or bismuth subsalicylate

53
Q

How evaluate dcrsd platelets?

A

First determine if due to dcrsd prodxn or Incrsd destrxn

54
Q

Causes or dcrsd platelet prodxn?

A

Viral (HCV, HIV, EBV) chemo, MDS, etoh, fanconi, b12, folate

55
Q

Causes of platelet destrxn.

A

Heparin (HIT) DIC, TTP, HUS, antiphospholipid syndrome, EDTA causes platelets to clump giving false dcrsd read.

56
Q

What is the schilling test?

A

Determines cause of B12 deficiency (pernicious anemia vs malabsorption).

57
Q

Effect of folate and b12 deficiency on CBC

A

Causes pancytopenia

58
Q

Iron studies findings in anemia of chronic disease?

A

Low/nl mcv, low Fe, low transferrin/TIBC, Incrsd ferritin

59
Q

What Is ARDS?

A

Injury to lung due to alveolar flooding, atelectasis, and svr O2 deficiency w/out HF. Px w/ acute onset bilateral opacities on cxr.

60
Q

What are si/sx of ARDS?

A

Shob, tachypnea, Incrsd ox requirement,

61
Q

How manage ARDS?

A

Usually reqs mech vent in ICU. Minimum of 5 PEEP. W/ adjusted fio2 requirements, Decrease o2 as able too and modest use of steroids

62
Q

How does malignant otitis externa px?

A

Most often 2/2 P.A. infxn, px w/ ear pain w/ drainage, commonly have granulation tissue in ear canal. Can affect facial + other CN

63
Q

Who is susceptible to rhizopus infxn?

A

poorly controlled diabetics, px w/ paranasal sinus infxn

64
Q

What facotrs found w/ RA?

A

anti-ccp and rheumatoid factor

65
Q

what is anti-dsDNA significant for?

A

highly specific for SLE

66
Q

How do benzos intox px?

A

Like ETOH intox, slurred speech drowsiness, unsteady gate

67
Q

What is a cataract?

A

progressive thickening of the lesn that leads to worsened vision. Px w/ blurred vision and glare

68
Q

How does retinal detachment px?

A

“Curtain falling over eye” or obscurring of part of visual field.

69
Q

How does macular degen px?

A

progressive, slow loss of vision if dry type of mac degen, will get wave lines or loss of central vision with wet type of mac degen

70
Q

What causes myasthenia gravis?

A

Ab against post-synaptic Ach receptor.

71
Q

What else must be assesed with Myasthenia Gravis?

A

Need chest CT to r/o thymoma

72
Q

How do head and neck cancers px?

A

hard non-tender LN in submandibular or cervical region. Commonly in smokers

73
Q

Si/Sx of allergic interstitial nephritis?

A

acute renal fail, arthralgia, rash, common w/ sulfa drugs, WBC casts of eosinophils, eosinophiluria

74
Q

Si/Sx of PSGN?

A

hematuria, mild proteinuria, RBC casts + fluid retention w/ periorbital edema.

75
Q

What is histoplasmosis?

A

dimorphic fungus found in Missouri+Ohio river valleys

76
Q

How does disseminated histo present?

A

Low grade fvr, malaise, anorexia, weight loss, palatal ulcers. Also LAD, HSM, pancytopenia. Hilar LAD on CXR.

77
Q

How does blastomycosis px?

A

rarely affects immunocompetent pts, px w/ multiple lung nodules or dense consolidation on cxr, see ulcerations of skin, verrucuous skin lesions, plaque like lesions on mucus membranes, osteolytic bone lesions

78
Q

What are anti-influenza tx and how used?

A

oseltamivir + zanamavir r neuroaminidase inhibitors, must be started in first 48 hrs. Also rimantidine or amantadine for Influ A

79
Q

How does toxic shock syndrome px?

A

mechanic hands (desquamation, includ palms/soles), fvr>102, hypotension, diffuse erythroderma, vomit/diarrhea, myalgia w/ incrsd CK, incrsd Cr, low platelets, Incrsd ALT/AST

80
Q

How does SJS px?

A

prodrome of fvr + flu sx, then mucocutaneous erythematous + purpuric macules that necrose/slough

81
Q

What is best screening test for androgen secreting neoplasm?

A

serum T + DHEAS, if incrsd androgens, w/ NL DHEAS, then ovary/testicle is source, if incrsd DHEAS, w/ nml T, then adrenal source

82
Q

Lytes criteria?

A

Exudate if pleural Prot/ serum Prot>0.5, pleural LDH/serum LDH>0.6, pH<7.30,

83
Q

normal pH of pleural fluid?

A

7.6

84
Q

What is tennis elbow?

A

lateral epicondylitis due to repeated wrist extension and supination.

85
Q

How tennis elbow px?

A

px w/ pain on lateral epicondyle thats worse w/ use, get degen of extensor carpi radialis brevis

86
Q

What is risk fx after having ankylosing spondylitis for >2 decades?

A

incrsd risk for vertebral fx, px w/ sudden onset of svr back pain, can occur even w/ minimal trauma in presence of AS.

87
Q

How vertebral fx pain diff from muscle spasm?

A

both acute in onset and can be severe but spasm tends to only last short time.

88
Q

Si/sx of blastomycosis?

A

can be disseminated even in immunocompetent, lung infxn w/ widespread extrapulmonary disease, wartlike lesions, violaceous nodules, skin ulcers

89
Q

What is lithium effects on endocrine system?

A

can cause hypothyroidism w/ goiter, also hypercalcemia, diabetes insipidus

90
Q

Cause of hypercalcemia w/ low PTH?

A

malignancy, vit D toxicity, or granulomatous disease

91
Q

Si/sx of upper airway obstrxn?

A

dysphagia, dyspnea, likely 2/2 to allergic rxn, stridor & harsh expiratory sound

92
Q

Si/sx of intracranial htn?

A

diffuse HA, esp in AM, n/v, vision changes, papilledema, CN deficits, somnolence, confusion

93
Q

tx for diabetic foot ulcer?

A

off loading (no weight on foot), debirdement, wound dressing, ABX, revasculariz if necessary, amputation

94
Q

Cuase of low serum Ca and incrsd PO4?

A

chronic renal failure or primary hypoparathyroidism

95
Q

Serum levels of Ca/PO4 w/ pagets?

A

Nml Ca and nml PO4, incrsd Alk Phos

96
Q

What causes rickets?

A

low vitamin D levels in Kids -> low Ca and low Phos

97
Q

Common cause of recurrent pneumonia?

A

alcohol intake px as recurrent RLL pneumo, recurrent pneumonia in same location more likely due to local obstrxn

98
Q

Si/sx of aspiration pneumonia?

A

indolent course usually, foul smelling sputum, usually due to oral flora

99
Q

How does acute viral myocarditis px?

A

URI followed by sudden onset of CHF, suggestive of dilated cardiomyopathy, due to dilated ventricles w/ hypokinesia

Uworld questions (13 decks)

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