uworld deck 5 Flashcards
most effective tx for COPD?
smoking cessation
best way to dcrs risk of CV disease?
smoking cessation
What is common complication of gastric bypass?
stomal stenosis -> stricture of anastamosis of gastric pouch and jejunum
Systemic effects of COPD?
svr COPD can cause weight loss, skeletal muscle dysfxn, incrsd CV morbidity and mortality
How best eval secondary amenorrhea?
best to do progestin w/drawal challenge
How eval abnormal uterine bleeding?
do endometrial bx after pelvic exam and pap smear
si//sx of cellulitis?
rapidly spreading, dermal and subcu infxn, most freq caued by staph aureus or GAS. px w/ well demarcated area of warmth, swelling, tenderness, erythema
What is presentation of seborrheic dermatitis?
scalp/ face rash w/ erythematous lessions w/ dry or greasy scales or crusts.
How tx seborrheic dermatitis?
low potency steroids on face, ketoconazole cream, medicated shampoos
What is rosacea? Si/sx?
chronic inflamm of skin, usually on face. >30 y/o pt. px w/ erythema, telangiectasia, pustules, papules
How does tinea cruris px?
involves groin, rarely scrotum, may have central clearing w/ darker border
Most common cause of erthema multiforme?
most often infxs cause… esp herpes simplex
How does erythema multiforme px?
appears as targetoid lesions.
How tx acute herpes zoster?
oral famciclovir w/in 72 hrs of formation of herpetic rash.
How differentiate SLE malar rash from rosacea?
malar rash spares nasolabial folds and areas below nares and lower lip. Rosacea won’t have systemic SLE sx
How tx inflamm Acne?
tx w/ oral ABX
What are types of Acne?
non-inflamm acne -> open and closed comedones, inflamm acne -> papules, pustules, nodules
What are non-concerning signs w/ LAD?
yng pt, <2 cm, freely mobile, rubbery, recent infxn
best method for screening of hearing impairment in adults?
whispered voice test
Best wy to eval fall in elderly?
get up and go test - > asses balance and gait
How tx urge inconctinence?
tx w/ anticholinergic like oxybutinin, can also use tolterodine
How manage young pts w/ mild/ pre-htn?
begin w. lifestyle changes, Dash Diet
Si/sx of coarctation of aorta?
Lower pulse delayed cmprd w/ upper extrem pulse, lower bp in lower extrem, will see rib notching on cxr, systolic and diastolic murmurs over back due to collateral formation.
How tx stg 2 htn?
systolic >=160 or diastolic >=100, begin w. 2 drug therapy
Mostcommon paraneoplastic syndrome assoc w/ squam cell carcinoma of lung?
PTH related peptide - > hypercalciemia
Sis/sx of GVHD?
rash on face, hands, feeet blood diarrhea, Incrsd LFTs, jaundice
What is cause of GVHD?
activation of donor lymphocytes against recipients wbcs/ rbcs
What is significance of positive prussian blue stain of UA?
demonstrates hemosiderin presence in blood suggesting oxidative stress
Most common cause of myocarditis?
viral, esp coxsackie A&B
How manage variceal bleeding?
majority stop spontaneously, can tx w/ vasoconstrictors -> octreotide, somatostatin, terlipressin
What is one result of incrsd CO in blood?
dcrsd O2 delivery to tissues leading to anearobic metabolism and lactic acidosis
effect of steroids on acid-base state?
can cause hypokalemia w/ metabolic alkalosis
effect of OSA on acid base?
causes resp acidosis
first step in tx of acute decomp HF?
give lasix, do not give beta blockers as will cause exacerbation
Side effects of EPO use?
worsenign of htn, HA, flu-like sx, red cell aplasia
tx of acute angle glaucoma?
timolol, acetazolamide, mannitol, pilocarpine
AVOID Atropine
Clinical fx of IBS?
recurrent abd pain/ discomfort for past 3 months + sx improvement w/ BM, chng in freq of stools, chng in form of stools, commonly px as chronic crampy ab pain.
Lab findings sugg of gallstone pancreatitis?
ALT>150, incrsd alk phos
What is most common cause of svr mitral regurg in developed nations?
mitral valve prolapse
How does anserine bursitis px?
pain centromedial just below joint line of knee, can occur due to abnormal gait, overuse trauma
What r risks of tamoxifen?
incrsd risk of endometrial cancer and VTE
How does rubella present?
erythema/ maculopapular rash starts on face and moves to trunk and extrem, have fvr, LAD, arthralgia
Risk w/ naficillin?
Can cause acute interstitial nephritis.
What is tx for reactive arthritis?
1st line therapy is NSAIDS (NOT ABX)
What is hiearchy of evidence?
- meta-analysis of RCT, 2. RCT 3. Cohort, 4. case-control, 5. case series.
What are cross-sectional studies?
snapshot of population at given pt in time
What is a case control study?
pts selcted cause they had specific outcome (like disease), and their hx is retrospectively reviewed to ID exposure or risk fx.
What is cohort study?
subjects are slected because of exposre (like smoking, living in certain city), and followed over time to watch development of disease
What is RCT?
type of cohort study w/ control group and study group. Pts randomly assigned to each group.
What is sensitivity? Eqtn?
true +/ true (+) + false (-), essentially rate of false negative
What is specificity? What eqtn?
true (-)/ true (-) + false (+), used for disease confirm, may have false (-) but no false (+)
What is PPV?
if pt tests (+), what r odds pt has disease, true (+)/ true (+) + false (+), depends on prevalence and sensiti/specific
What is NPV?
prob of having disease in pt who tests (-). true -/ true (-) + false (-). high NPV important screening test
Concern in diabetic w/ upper motor neuron sx?
At risk for epidural abscess. Get MRI.
How does diabetic neuropathy usually dx?
usually only dx based on clinical exam finding, no EMG studies needed.
If positive for GC/CT, what w/u needed?
Do HIV serology, Pap smear, RPR, hep B
What is concern w/ recent travel and pneumonia?
If nothing on gram stain and recent travel, esp w/ hotel/ cruise stay, concern for legionella.
How tx legionella?
tx w. azithromycin
Si/sx of legionella infxn?
high fvr >39, GI sx, neuro sx, rales, focal lobar consolidation on cxr, must cx on charcoal agar.
How manage SIADH?
if as/mild - > do fluid restrxn, if mod or sx - > hypertonic saline in 1st 3-4 hrs. Want sodium >120.
What are causes of acute epididymitis?
Sexually transmitted - > if associated w/ pain @ tip of penis & urethral dc. Non STD if assoc w/ UTI or UTI sx preceding episode
What is primary biliary cirrhosis?
Chronic liver disease w/ autoimmune destrxn of intrahepatic bile duct and cholestasis.
WHat are si/sx of PBC?
severe pruritis, fatigue, hsm, xanthomatous lesions
WHat antibody assoc. w/ PBC? What associated disease occur w/ PBC?
Antimitochondrial AB, associated w. sjogrens, reynauds, scleroderma, autoimmune thyroid disease. hypothyroidism, celiac disease
How tx PBC?
ursodeoxcholic acid - > slows progression & relieves sx. Only do liver xplant if having advanced liver damage or cirrhosis
What is most common cause of primary adrenal insufficiency in developed nations?
autoimmune adrenalitis. Due to antibody against steroidogenic enzymes.
What is px of primary hypoaldosteronism?
hoTN, pigmentation, hypoNa, hyperK, eosinophilia, incrsd ACTH, low cortisol
What Ab cause hashimotos?
anti-TPO and anti-thyroglobulin Ab
What causes graves Dx?
thyroid stimulating immunoglobulins
What is equation of absolute risk redxn?
Arr- RRR grp 1 - RRR grp 2
What is equation for NNT?
NNT = 1/ARRR
To Incrs sensitivity whwat must be incrsd?
must incrs true negative value
How does giant cell tumor px?
expansile and eccentric lytic area of bone on xray. px w/ pain, swelling, dcrsd ROM, pathologic fx
How does osteoid osteoma px?
sclerotic cortical lesion w/ central lucency (soap bubble appearence), px w/ pain that’s worse @ night and unrelated to activity.
WHat is effect of pulmonary edema on lungs?
leads to V/Q mismatch, incrsd A-a gradient, nl or incrsd PaCO2, can correct w/ supplemental O2
What diseases cause V/Q mismatch?
obstructive lung disease, atelectasis, pulmo edema, pneumonia
What is nl A-a gradient?
<15, but increases with age.
What is medical treatment for essential tremor?
beta blocker or primidonee
What are adv rxns w/ primidone?
can lead to acute intermitten porphyria, ab pain, neurologic, psychiatric
What causes blood at beginning of urination?
lesion in urethra (urethritis)
Waht causes blood @ end of urination?
prostatic or bladder cause, can px w/ clots in urine.
Blood during entire cycle of urine?
usually ureter or kidney cause, will not have any clots
What is px of mixed essential cryoglobulinemia?
Presents w/ hematuria, RBC casts, proteinuria, and palpable purpura in hep C pt?
Px of allergic conjunctivitis?
watery d/c, itchiness, hx of allergies, diffuse conjunctival infxn, follicular or bumpy conjunctival edema.
How does viral conjunctivitis px?
usually unliateral, watery d/c, burning, sandy sensation.
How manage peripheral arterial embolism?
Initiate heparin & if limb salvageable then start embolectomy
How differentiate DI and psychogenic polydypsia?
DI is hypernatremic where psychogenic polydip px w/ hyponatremia
How work up recurrent pneumonia?
If in some anatomic region, then likely underlying anatomic prob or obstrxn, Do CT to further ID
Causes of recurrent pneumonia?
If same region - > bronchial compression, obstrxn (FOB, bronchial stenosis, bronchiectasis).
How tx svr or sx hypercalcemia?
If w/ sx or > 14 -> NS infusion, no loop diuretics unless HF px. Long term tx w/ bisphosphonates
Clinical si/sx of cushing?
prox muscle weakness, skin thinning, central obesity, htn, hypergluc, skin hyperpigmentation
Si/sx of diverticulitis?
fvr, N/Vconstip, leukocytosis, LLQ pain
How does sideroblastic anemia px?
microcytic hypochromic anemia w/ nml or incrsd Fe, w/ dimorphic RBCs. Tx by giving pyridoxine.
How manage antiphospholipid syndrome?
give LMWH if prego to dcrs risk of spontan abortion
What must be done if having radiating acute epigastric pain?
Must do ecg to r/o MI
What are muscarinic antagonists used for COPD?
ipratropium and tiotropium
How manage prego women w/ hep C?
vaccinate against A and B, can breast feed following delivery. Do not need to do C-section
What is definitive tx for Graves? Contraindications?
radioactive iodine tx. Dont do if prego or have svr opthalmopathy
Si/sx of UC?
bloody diarrhea, tenesmus, cramping, weight loss, anemia
Extraintestinal manifestations in UC?
sclerosing cholangitis, uveitis, eryhtema nodosum, spondyloarthropaty.
