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Uworld questions > uworld deck 6 > Flashcards

uworld deck 6 Flashcards

0
Q

RIsk w/ hearing in HIV pts?

A

incrs risk for serous otits media (non-infxs otitis) due to lymphadenopathy blocking Eustachian tube

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1
Q

What is otosclerosis?

A

Boney overgrowth of middle ear bones

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2
Q

How differentiate PE from tension pneumo?

A

breath sounds absent w/ pneumo, but present with PE

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3
Q

How does polymyalgia rheumatica px?

A

Typically pt >50, aching pain in neck, shoulder, pelvis, for >= 1 mnth, morning stiffness >1 hr & nml PE

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4
Q

How tx polymyalgia rheumatic?

A

low dose steroids

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5
Q

Most common complication of PUD?

A

Can get hemorrhage

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6
Q

How best stop progression of diabetic nephropathy?

A

must do intensive BP control - > glycemic control has no effect. BP target is <130/80

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7
Q

If exudative effusion, what is cause?

A

Can be infxs, autoimmune, neoplastic. All due to incrsd capillary permeability.

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8
Q

Inherited cause of gait abnormalities?

A

Friedrichs ataxia and ataxia telangiectasia

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9
Q

What is friederich’s ataxia?

A

AR disease w/ onset in young adulthood, px w/ nystagmus, ataxia, impaired vib sense and propioception

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10
Q

What is ataxia telangiectasia?

A

AR disease w/ onset in childhood, px w/ sx like friedrichs with addition of telangiectasias. Has incrsd risk of cancer

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11
Q

How tx tourret’s disease?

A

pimozide, clonidine, haloperidol

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12
Q

What is most commonc ause of dementia?

A

Alzheimer’s most common cause - 2/3 of all cases

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13
Q

WHat is binswanger disease?

A

Insidious onset due to diffuse subcortical white matter degen. Most often in pts w/ long standing htn and atherosclerosis.

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14
Q

How does Pick disease px?

A

clinically identical to alzheimers.

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15
Q

Drugs w/ adverse cognitive side effects?

A

Glucocorticoids, opioids, sedative hypnotics, anxiolytics, anticholinergics, lithium

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16
Q

Early si/sx of alzheimers?

A

forgetfullness, poor performance at work, poor concentration, personality cahgnes, impaired judgement

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17
Q

Later stages of alzheimers?

A

assistance needed for baseic skills, forget names, paranoid delusions, hallucinations

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18
Q

How dementia with lew body px?

A

fx of alzheimers and parkinsons. Begins with visual hallucinations, may have EPS sx.

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19
Q

Causes of delirium?

A

mnemonic P. DIMM WIT

postop, dehydration/malnutrition, infxn, meds/drug intox, metals, withdrawal, inflamm, fvr, trauma/burns

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20
Q

How differentiate iron deficiency anemia from anemia of chronic disease?

A

ACD px w/ dcrs TIBC/xferrin and incrsd ferritin. In Fe deficiency px w/ incrsd TIBC/xferrin, dcrsd ferritin

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21
Q

How define aplastic anemia?

A

pancytopenia, low retic count, hypoplastic marrow, w/ <20% cellularity and nml maturation of all cell lines

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22
Q

What is cause of autoimmune hemolytic anemia?

A

Interferron activated T lymphocytes cause autoimmune destrxn of stem cells

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23
Q

What is cause of autoimmune hemolytic anemia?

A

Interferon activated T lymphocytes cause autoimmune destrxn of stem cells

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24
Q

How does warm Ab mediated hemolysis appear on smear?

A

Appear like hereditary spherocytosis w/ small spherocytes

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25
Q

How dx cobalamin deficiency?

A

Must do methlymalonic and homocyteine levels if concern for B12 deficiency as B12 levels may not fall till later

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26
Q

Blood smear w/ Fe deficiency?

A

Hypochromic, anisocytosis, poikilocytosis

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27
Q

Signs of hemolysis?

A

incrsd LDH, dcrsd Haptoglobin, anemia w/ reticulocytosis, incrsd unconj bili and uric acid

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28
Q

What is inheritance of hemophilia A?

A

X linked recessive, rare in females

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29
Q

How does platelet related bleeding occur?

A

Tends to occur immediately after injury, usually mucous membranes, skin w/ petechiae

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30
Q

How does coag related bleeding appear?

A

Usually delayed in onset w/ deep tissue bruises (ecchymoses)

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31
Q

How tx acute chest syndrome?

A

tx w/ RBC exchange xfusion in acute situ. Long term tx w/ hydroxyurea.

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32
Q

Best way to dx osteonecrosis?

A

Best to dx w/ MRI

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33
Q

What is triad of TTP?

A

hemolytic anemia, thrombocytopenia, CNS sx. Can dx w/ major defic of ADAM13 in serum.

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34
Q

Best tx for immune thrombocytopenia purpura?

A

BEst to tx w/ steroids do so if sx bleeding and platelet counts < 15k. Splenectomy is 2nd line.

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35
Q

When test for thrombophillia if anticoaged?

A

only do thrombophilia screening @ 1st 2 weeks after stopping anticoag tx.

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36
Q

How manage pt w/ antiphospholipid Ab syndrome?

A

Following first thromboembolic episode, anticoag indefinitely

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37
Q

What abx px w/ antiphospholipid Ab syndrome?

A

anticardiolipin Ab, B2 glycoprotein 1, lipid anticoag ab

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38
Q

How dx MGUS?

A

low serum monoclonal protein <3 g, less than 10% plasma cells in BM & absence, no signs of multiple myeloma.

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39
Q

What type of cell px in CLL?

A

Cd5, cd20+, cd23+, B cells

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40
Q

What are si/sx of cml?

A

Bcr/abl, 9:22 xlocation, incrsd granulocytes w/ left shift on smear, hyper cellular bone marrow w/ myeloid prolif.

41
Q

How does fictitious fevers px?

A

High for spikes in unusual patterns w/ no diurnal variation.

42
Q

If paralytic and high fever and muscle rigidity?

A

Malignant hyperthermia

43
Q

Goals of tx w/ sepsis and septic shock?

A

Aggressive fluid resuscitation, mvO2 >= 70%, CVP of 8-12, MAP >=65, UOP >=0.5

44
Q

What is one tx aspect of severe sepsis?

A

Activated protein C

45
Q

When use vasopressors?

A

If adequate fluid resusciation with MAP consistently below 65 mmhg

46
Q

What is definition of severe sepsis?

A

Sepsis w/ end organ damage, hypotension, hypoperfusion

47
Q

Most common cause of peritonsillar abscess?

A

Grp A beta hemolytic strep

48
Q

Px of peritonsillar abscess

A

Worsening of sore throat w/ ABX therapy, fvr, dysphasia, pooling of saliva, drooling, muffled voice. Enlarged tonsils w/ uvular deviation.

49
Q

How manage peritonsillar abscess.

A

Urgent ENT consult

50
Q

Most common causes of otitis media in adults?

A

Strep pneumo, h. Influ, staph, moraxella

51
Q

How tx otitis media in adult?

A

Best to tx w/ amoxicillin. If fails by 48-72 switch to augmentin, Rocephin, oral macrolides.

52
Q

Most common cause of acute sinusitis?

A

Most by viruses, 2% by bacteria so don’t need for anything but symptomatic tx.

53
Q

If acute prostatitis fails ABX tx?

A

Must do trans-rectal US to r/o prostatic abscess.

54
Q

What is tx for pyelo?

A

7-14 days of fluoroquinolones (levoflox, or Cipro), can’t use bactrim due to incrsd resistance

55
Q

What sti’s should be screened for in women under 25?

A

HIV, chlamydia, gonorrhea

56
Q

Px of disseminated gonoccal infxn?

A

3rd gen cephalosporin

57
Q

How tx PCP pneumonia?

A

Bactrim + steroids. Can use dapsone as adjuvant or as prophylactic if intolerant of bactrim.

58
Q

When at risk for toxo?

A

Cd4 less than 100.

59
Q

How tx toxo HIV infxn?

A

Tx w pyrimethamine + sulfadiazene.

60
Q

What precautions should be used with n. Meningitis?

A

Requires face mask and droplet precautions

61
Q

What is adverse rxn with isoniazid tx? How prevent?

A

Can get peripheral neuropathy. Protect against with pyridoxine supplementation.

63
Q

When CAP likely due to MRSA?

A

Svr rapidly progressing pneumo, cavitation infiltrates, or if hx of MRSA infxn elsewhere

64
Q

How tx severe CAP?

A

cefotaxime, levofloxacin, vanc

65
Q

Best test for legionella?

A

legionella antigen test

66
Q

Most common cause of pneumonia in adults?

A

S. pneumo, myco pneumo, chlamydophila pneumo

67
Q

How tx CAP?

A

If not severe start with just azithromycin

68
Q

Best tx for aspiration induced lung abscess?

A

Augmentin (amp- sulbactam) provides wide spec coverage with anaerobic coverage.

69
Q

Who needs ABX PPX?

A

if have prosthetic cardiac valves, hx of prior infective endocarditis, unrepaired cyanotic HD, cardiac xplantation w/ cardiac valvulopathy

70
Q

Most likely cause of infective endo in IV drug user?

A

most likely MRSA, could also be G- bacili like P.A.

71
Q

How tx infective endo w/ septic emboli?

A

use vanc + cefepime which covers MRSA and G - rods

72
Q

If diabetic foot ulcer, how w/u?

A

determine depth of ulcer, if down to bone, do bone biopsy to determine what definitive treatment needed

73
Q

What is best test to dx vertebral osteomyelitis?

A

spinal MRI

74
Q

How w/u pt w/ diabetic foot ulcer that does not reach bone?

A

Do MRI to determine if boney involvement

75
Q

What is 1st step w/ pt w/ image proven vertebral osteomyelitis?

A

Must order blood cx which can prevent need for bone biopsy

76
Q

Major cause of glomerular hematuria after URT infxn?

A

IgA and PSGN most common.

77
Q

How differentiate IgA nephropathy and PSGN

A

IgA nephropahty has nml complement levels and begins <5 days after infxn, while PSGN has low complement and begins 10 days after.

78
Q

Si/sx of drug induced interstitial nephritis?

A

fvr, rash, arthralgia, periph eosinoph, steril pyuria, eosinophiluria, WBC casts

79
Q

Major side effect of sulfonylureas?

A

weight gain and hypoglycemia

80
Q

What class of drugs is pioglitazone? Side effects?

A

thiazolinediones — weight gaine, edema, CHF, bone fx, bladder cancer

81
Q

Benefit of GLP-1 drug

A

Exenatide — low hypoglycemia risk w/ possible benefit of weight loss

82
Q

Physical exam findings of pnuemonia?

A

incrsd tactile fremitus, presence of egophany, bronchophony, whispered pectoriloquy. bronchial breath sounds px.

83
Q

Most common sx w/ mitral regurg?

A

exterional dyspnea + fatigue due to dcrsd cardiac output + incrsd left atrial pressure. holosystolic murmur at apex w/ radiation to axilla.

84
Q

Si/sx of constrictive pericarditis?

A

elevated JVP, muffled/ distant heart sounds, pulsatile hepatomegaly, signs of fluid overload

85
Q

What does rheumatoid arthritis perdispose ones kidneys to?

A

can get amyloidosis of glomeruli

86
Q

How renal amyloidosis px?

A

enlarged kidneys, hepatomegaly, amyloid deposits w/ apple-green birefringence under polarized light w/ congo red.

87
Q

What causes granular deposits on immunoflorescence of glomeruli?

A

PSGN and lupus nephritis - > both due to immune complex nephritis

88
Q

What is risk w/ hodgkins lymphoma tx?

A

if tx @ young age, esp before 30, then incrsd risk of secondary malignancy in 30% of pts after ~~30 yrs

89
Q

Most common secondary malignancies due to hodkins lymphoma tx?

A

breast, thyroid, bone, GI, acute leukemia

90
Q

What vaccines do ALL HIV pts need?

A

pneumovax, meningocc vac if asplenia or in risky group, influenza annually, MMR if cd4>200, H. influe Type B, tdap q5yrs, hep B

91
Q

What vaccines contraindicated in HIV?

A

oral polio, varicella, zoster, MMR if CD4<200

92
Q

Gene associated with FAP?

A

APC gene, AD inheritance

93
Q

How tx FAP?

A

on 1st px of numerous polyps, do electie proctocolectomy

94
Q

What cancers assoc w/ H. Pylori

A

Gastric lymphomas no adenocarcinomas

95
Q

What is classic triad of carcinoid syndrome?

A

flushing, valvular HD, diarrhea, requires hepatic metastasis of primary tumor

96
Q

What is nutritional concern for carcinoid syndrome?

A

serotonin produced from trytophan which is needed in synthesis of niacin. SO can develop niacin deficiency w/ serotonin syndrome.

97
Q

SX of niacin definciency?

A

diarrhea, dermatitis, dementia

98
Q

si/sx of OA?

A

morning stiffness for 30-60 minutes, pain worse w/ activity, better w/ rest, usually in pts >40

99
Q

Bone risk w/ chronic steroid use?

A

incrsd risk of osteonecrosis (esp of hip), px w/ prog anterior hip and groin pain

100
Q

si/sx of hypercalcemia?

A

severe constipation, anorexia, weakness, incrsd urination (osmotic agent) or neuro abnormalities. (stones, bones, groans, psych overtones)

Uworld questions (13 decks)

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