UWorld Errata Flashcards
Dense deposits within GBM on EM in setting of proteinuria, hematuria, and IF positive for C3 is what glomerulopathy?
Activation of what pathway is responsible for the damage done by this disease?
Membranoproliferative glomerulonephritis, Type II
Causes by IgG antibodies (C3 nephritic factor) which causes persistent activation of the complement pathway by activating C3 convertase. Thus, most of this disease is complement mediated
What effect do oral contraceptive pills (OCPs; combined estrogen/progestin) have on risk for endometrial and ovarian cancer and how?
Name the three major risks of OCPs.
Reduce risk of endometrial and ovarian cancer. Endometrial risk reduced by progestin effect on stabilizing endometrium. Ovarian risk reduced by suppression of ovulation.
Hypertension, venous thromboembolism, hepatic adenoma
Patient presents with repeated history of edema (face, limbs, genitals, laryngeal, abdomen - causing colicky pain) without urticaria. What is the likely diagnosis and what is the pathogenic mechanism causing it?
What sorts of events do these episodes usually follow?
Hereditary angioedema due to C1 inhibitor deficiency which leads to elevation of bradykinin levels.
Infection, dental procedures, trauma
Young child presents with persistent ear drainage unresponsive to antibiotic therapy. Over the past week she is experiencing new unilateral hearing loss. On inspection of ear there is a retraction pocket of the TM with granulation tissue surrounding it and minor skin debris. What is the likely diagnosis?
Choleastoma
An IV drug user presents with fever, cough, and weakness. CXR shows scattered round lesions in the peripheral lung fields.
What does the patient have?
What valve is affected?
What type of murmur is appreciated?
What will happen to this murmur on inspiration and why?
- Infective endocarditis
- Tricuspid valve
- Tricuspid regurgitation
- Increases because inspiration causes a negative pressure which causes increased venous return that accentuates right-sided heart sounds
When a brain abscess results from sinusitis or some other head/neck infection what are the most common pathogens involved?
Viridans Streptococci (e.g. S. intermedius, S. mitis, S. oralis, S. mutans) Anaerobic bacteria
How does a disseminated gonococcal infection typically present?
Are blood cultures definitive?
What is the treatment?
Either purulent arthritis w/o skin lesions OR tenosynovitis, dermatitis, and a migratory asymmetric polyarthralgia w/o purulen arthritis
Blood cx are often negative
IV ceftriaxone followed by PO cefixime, joint drainage, empiric azithromycin or doxycycline for possible Chlamydial infection, treat sexual partners too.
What is the biggest risk factor for cerebral palsy?
How can the spasticity be managed?
Premature birth (
What is the INR goal for patients with idiopathic venous thromboembolism when treated with warfarin?
Goal INR is 2.5
Acceptable range is 2.0 - 3.0
Patient presents with itchy lesions over his trunk which are ring-shaped with central clearing and have scaly borders.
What is the diagnosis and what test/result is used to confirm?
Pathogen?
Tx?
Tinea corporis. Microscopic exam with KOH should reveal hyphae
Trichophyton rubrum
Topical terbinafine or systemic griseofulvin
Why is doxycycline not recommended for use in children and pregnant woman?
What is the treatment of choice for Lyme disease in pregnant woman?
Doxycycline can discolor teeth in children and retard skeletal development in children and fetuses
Amoxicillin
What classically presents with dyspareunia, dysmenorrhea, and dyschezia (pain with defecation)?
What is the recommended treatment and how does the treatment help to reduce symptoms?
Endometriosis
NSAIDs and OCPs. OCPs suppress ovulation which help reduce symptoms.
*If a patient has these classic symptoms then a definitive diagnosis does not have to be pursued unless the pain is severe, they need to exclude malignancy, or treat infertility
What are the best two measurement to follow when looking for resolution of diabetic ketoacidosis?
Serum anion gap and beta-hydroxybutyrate
A patient presents with mild gynecomastia, erectile dysfunction, decreased libido, but no headaches or visual changes. On work-up he has reduced testosterone. He has diabetes which is controlled. Do you continue your diagnostic work-up or treat and what is the next step?
Check prolactin levels first. If high then a brain MRI is warranted. If normal you may opt to treat with testosterone therapy.
An alcoholic patient who is also a vegetarian presents with lethargy and pallor. You treat with thiamine and folic acid. A few months later he returns with increasing forgetfulness and falls. What did he have and what happened after treating with folic acid?
He likely had a combination folic acid and B12 deficiency from being an alcoholic and vegetarian. By treating with folic acid you likely helped his folic acid deficiency anemia and reduced his megaloblastosis but no treating with any vitamin B12 likely caused rapid progression of B12-related neurologic symptoms
Are uric acid stones radiolucent or radioopaque?
What is the appropriate treatment?
Radiolucent
Hydration, alkalinization of urine with potassium citrate, and a low purine diet
A patient presents after being involved in an unrestrained MVA with chest pain, SOB, and tachycardia. He has a broken femur. Upon administration of 2 liters IV fluids his symptoms continue and worsen. What is the most likely diagnosis?
Pulmonary contusion secondary to blunt trauma
Fat embolism is less likely since it takes 12-72 hrs to manifest and often had petechiae present too
T/F
Patients with primary hyperaldosteronism often don’t have spontaneous hyperkalemia.
What can precipitate hyperkalemia in these patients?
True
Diuretic-use can lead to large hypokalemia
What disease is dermatitis herpetiformis associated with and what are treatment options?
Celiac disease
Follow a gluten-free diet. Dapsone.
What are typical treatments for Tourette’s disorder?
1) First gen antipsychotics (e.g. Haloperidol, Pimozide)
2) Second gen antipsychotics
3) Alpha adrenergic receptor agonists (e.g. clonidine, guanfacine)
An adult presents with recurrent bacterial infections. What test should you do first?
Measure serum IgG levels to check for selective immunodeficiency
What does thyrotoxicosis due to blood pressure and circulation and how?
Increases blood pressure and leads to increased cardiac output and atherosclerosis
What drugs most commonly cause a serum-sickness like reaction?
What are the symptoms?
B-lactams and sulfa drugs
Fever, urticaria, arthralgia, and lymphadenopathy
What is vasa previa?
Vasa previa: fetal blood vessels traverse lower segment of uterus between fetus and internal cervical os which are prone to rupture.
How is schizoaffective disorder distinguished from major depression with psychotic features?
Both may have concurrent depression and psychosis. However, schizoaffective disorder has a >2 week period of psychosis in absence of depressive symptoms
Rheumatic heart disease due to untreated S. pyogenes infection commonly leads to what valvular abnormality?
Why is it more common to become symptomatic during pregnancy?
Mitral stenosis
During pregnancy patients become more fluid overloaded making pulmonary edema development more likely.
How does lactation itself exert its anticontraceptive effect?
What are acceptable methods of contraception in the immediate postpartum period?
Lactation is from prolactin which has an anovulatory effect by suppressing GnRH release.
Sterilization, IUDs, barrier methods, and progestin-based contraceptives. Progestins won’t effect milk volume or infant the way estrogen may
In patients who present with elevated ALP and hyperbilirubinemia what imaging modality will you use to further refine your differential?
Ultrasound to distinguish intrahepatic from extrahepatic cholestasis
What is enthesitis and in what disease does it commonly occur?
How may this present?
Enthesitis: inflammation occurring where tendons and ligaments attach to bone
Common in ankylosing spondylitis
May present with pain at heel, tibial tuberosities, and iliac crests
What do loop diuretics do to potassium levels?
Hypokalemia
Also a contraction alkalosis
Match the following terms with their appropriate study:
Odds ratio
Relative risk
Case-control study
Cohort study
In what situation does OR approximate RR?
Case-control studies yield odds ratios
Cohort studies yield relative risks
OR approximates RR when the disease is rare
A patient with a history of pelvic fracture and accompanying urethral injury s/p realignment presents with erectile dysfunction. What is the likely cause of his erectile dysfunction?
Damage to parasympathetic nerves and likely altered arterial supply during injury and realignment
Hemolytic anemias, including those which are microangiopathic, have what types of disturbances to haptoglobin, LDH, and bilirubin?
Decreased haptoglobin
Elevated LDH
Elevated bilirubin
What is the normal vaccination schedule for DTaP and TdaP booster?
What is the treatment of pertussis?
Five doses of DTaP between 2 months and 6 years of age
One TdaP booster between age of 11 and 18
Macrolide antibiotics (e.g. azithromcyin, clarithromycin)
Describe ecthyma gangrenosum
What pathogen typically causes it?
Starts as erythematous macule progressing to nodule with necrosis
Pseudomonas aeruginosa
If a patient presents with cough and sore throat followed by signs of reduced cardiac output in coming days (e.g. dizziness, weakness, syncope) with pulsus paradoxus on exam what do they have?
Cardiac tamponade secondary to acute viral pericarditis
What is the FEV1/FVC ratio in restrictive disease?
Obstructive disease?
Restrictive disease it is normal or > 80%
Obstructive disease it is
Paraneoplastic Cushing Syndrome is caused by what hormone release?
Why is their hyperpigmentation as well in this situation?
ACTH
ACTH has melanocyte-stimulating hormone as a cleavage product which leads to the hyperpigmentation
Pleural effusion caused by tuberculosis often has what characteristic findings for:
Protein:
Glucose:
WBC:
Protein: High, often > 4g/dL
Glucose: Mildly low compared to serum values
WBC: Lymphocytic predominance
Greater than ____ neutrophils/uL is considered diagnostic of spontaneous bacterial peritonitis in a paracentesis.
250
Why are LDH and CPK often elevated in patients with polymyositis?
They are the products of muscle breakdown in these patients
Does postictal confusion occur in patients with typical absence seizures?
What is a common cause of complex partial seizures in adults?
No
Temporal lobe epilepsy
What indicates stable ventricular tachycardia?
What is the immediate treatment of a patient with stable ventricular tachycardia?
Hemodynamic instability, so the presence of a pulse and no hypotension
Amiodarone
The presence of a shiny, thin, hairless extremity with a nonhealing ulcer should raise suspicion of what disease?
Peripheral vascular disease
Do an ABI
Patients who have gastric bypass surgery are at greater risk for developing _________.
Since that is the case they are often offered elective _____ at the same time.
If the deny the elective procedure they should receive ______ in the period after bypass surgery.
Gall stones
Cholecystectomy
Ursodeoxycholic acid
Describe how secondary hyperparathyroidism manifests itself
ESRD leads to hypocalcemia from failed activation of vitamin D and phosphate retention.
This produces a stimulus for PTH release and subsequent PTH gland hyperplasia
Is peritonitis considered somatic or visceral pain?
Somatic
What is used as prophylaxis to prevent esophageal variceal hemorrhage in patients with cirrhosis or ascites?
B-blockers
Do neoplasms of the gallbladder typically cause jaundice?
What should lead a differential when painless jaundice is the major complaint? What findings would you expect with labs?
No
Pancreatic cancer; elevated ALP, Tbili, mild elevations of LFTs
The CXR of a smoker has a unilateral upper lobe infiltrate with cavitation and hilar lymphadenopathy. What is this classic for?
Tuberculosis
At what age range do patients with CLL usually present?
What cell type predominates?
How can you explain anemia and thrombocytopenia in these patients?
What is a monoclonal Ab treatment?
60s to 70s
Lymphocytes
CLL pts often have concomitant autoimmune hemolytic anemia and immune-mediated thrombocytopenia
Rituximab (anti-CD20)
What bacteria are sickle cell patients particularly susceptible to?
What are the common pathogens responsible for the following diseases in sickle cell patients:
Pneumonia
Osteomyelitis/Septic arthritis
Sepsis
Meningitis
Encapsulated organisms: Strep, Neisseria PNA: Strep pneumoniae Osteomyelitis/septic arthritis: Staph aureus, Salmonella Sepsis: Strep pneumoniae Meningitis: Strep pneumoniae
Dilation of small bowel greater than ___ cm on radiograph and absence of air in colon suggests small bowel obstruction
3 cm
What is the procedure or treatment of choice in relieving intrahepatic and extrahepatic cholestasis, respectively?
Extrahepatic cholestasis: place endoscopic stent in common bile duct
Intrahepatic cholestasis: Ursodeoxycholic acid
Multiple myeloma is likely to lead to renal failure. Does it generally do this by affecting renal tubular or glomerular function and how?
Renal tubules are usually damaged by light chains
Hemoglobin A is the main Hb in human blood. What chains make it up?
How many alpha globin genes and beta globin genes are there within the human genome?
What are the types of alpha thalassemia based on number of alpha globin genes?
4 alpha globin genes (two on each chromosome 16) and 2 beta globin genes (one on each chromosome 11)
If all 4 alphas are mutated: hydrops fetalis
If 3 alphas are mutated: hemoglobin H (four beta chains) forms
If 2 alphas are mutated: heterozygous alpha thalassemia minor
In the presence of pre-existing joint abnormality (e.g. RA), what is more likely as the cause of fever and a monoarticular arthritis: septic arthritis or RA?
Septic arthritis
Do an arthrocentesis promptly before considering the use of antibiotics
A neonate presents with bilious vomiting and on upper GI series there is a corkscre-shaped duodenum. What should this raise concern for?
Intestinal malrotation or volvulus
What are the most common causes of bacterial meningitis in adults up to 60 years of age? What is empiric therapy?
When older than 60 and also immunocompromised what other pathogen must be accounted for? What drug should be added on?
S. pneumoniae, N. meningitidis, H. influenzae. Ceftriaxone and Vancomycin
Listeria monocytogenes. Ampicillin
What and where is the murmur of aortic regurgitation heard?
Decrescendo diastolic murmur over the left sternal border
In the pediatric population what pharyngitis symptoms generally indicate a viral pharyngitis?
What symptoms are concerning for bacterial pharyngitis warranted a rapid strep test and possible culture?
Viral pharyngitis: Cough, rhinorhea, oral ulcers
Bacterial pharyngitis: Exudates, palatal petechiae, absence of viral symptoms
Poststreptococcal glomerulonephritis is often seen following certain group A Strep infections. Which ones are more likely to precede it?
Impetigo
Describe the mechanism of urge incontinence vs overflow incontinence.
What is the first line treatment for urge incontinence?
Urge incontinence: detrusor instability leads to uninhibited contractions which lead to a sensation of voiding and leakage, often en route to the bathroom.
Overflow incontinence: Often neurogenic, but inability to sense need to void leads to intrabladder pressures that surpass urethral pressures leading to leakage
Urge Incontinence: first line is timed voids and creating a void schedule
Henoch-Schonlein Purpura
Takayasu’s arteritis
Wegener’s
Churg-Strauss Syndrome
Which is a leukocytoclastic vasculitis and which are granulomatous?
HSP is leukocytoclastic
A 55 yo male with a history of atherosclerosis, smoking, and HTN presents with new low back pain. On exam you hear a right carotid bruit. What emergent condition on your differential should you rule out first?
Abdominal aortic aneurysm
A patient presents after blunt chest trauma with a widened mediastinum on CXR. What is the next appropriate imaging modality to use for diagnosis confirmation?
CT scan of chest
Trans-esophageal echocardiogram
Where are Bartholin glands located?
How do cysts or abscesses at this location present and what is the appropriate treatment?
4 and 8 o’clock positions of labia majora
Obstruction of the ducts can lead to cyst or abscess formation. Will present as a tender, fluctuant mass that is very painful, especially during intercourse, sitting, or even walking.
Incision and drainage is recommended
What is appropriate therapy or management for patients with long-term cocaine use and addiction?
Psychotherapy and 12-step groups
*Chronic cocaine addiction may cause a “cocaine crash” the following days presenting as depresssion
What is the mechanism of action of the following migraine abortive medications?
Triptans
Ergots (e.g. dihydroergotamine)
Both are 5HT agonists which cause vasoconstriction and decrease neurogenic inflammation
What are the diagnostic criteria for Kawasaki disease (5 items)?
What serious complication are they at risk for and what may be given to them to reduce the risk of this complication (2 items)?
Fever greater than 5 days and 4 of the following 5 items
(i) Cervical lymphadenopathy >1.5 cm
(ii) Bilateral conjunctivitis
(iii) Mucosal ulcers, cracked lips, “strawberry tongue”
(iv) Polymorphous rash
(v) Erythema of hands and feet
Coronary artery aneurysms; intravenous immune globulin and aspirin
(one of the few reasons to give aspirin to a child)
Your elderly patient presents with painless vision loss which is worse at night. She describes a “glare” in her visual field when looking at bright lights. What is the likely diagnosis?
Cataracts (opacification of lens)
What medications have been shown to increase long-term survival in patients with decompensated CHF (e.g. LV systolic dysfunction)?
ACE inhibitors, ARBs, Beta-blockers, Spironolactone, and a combination of hydralazine and nitrates in African-American patients
*Certain beta-blockers indicated: metoprolol succinate, carvedilol, bisoprolol
What is the mechanism by which pulmonary edema develops in patients with pre-eclampsia/eclampsia?
Generalized arterial vasospasm increases afterload on heart which leads to elevated pulmonary capillary pressures and development of pulmonary edema
Also contributing are increased capillary permeability, decreased renal function, and reduced serum albumin
What are the expected values for protein and LDH in exudative pleural fluid?
What is a normal pH of pleural fluid? What pH is often found in transudate vs exudate?
Pleural protein/serum protein > 0.5
Pleural LDH/serum LDH > 0.6
Pleural LDH > 2/3 upper limit normal serum LDH
7.60
Transudate 7.40-7.55
Exudate 7.30-7.45
An HIV patient presents with a bright red, friable, firm, exophytic nodule. What is the likely diagnosis? Causative agent? Tx?
Bacillary angiomatosis
Bartonella
Erythromycin (macrolide)
Young male presents with mucopurulent urethritis but no organisms are isolated on gram stain or culture. What is the likely diagnosis?
Chlamydial urethritis
Need to do a nucleic acid amplification test
What are you more likely to see a pleural effusion in Strep pneumo or Pneumocystis pneumonia?
What is the most common cause of pneumonia in HIV infected patients?
Pleural effusion more likely in Strep pneumoniae
Strep pneumoniae
Ectopic foci located where generally cause afib?
Pulmonic veins
Are fever and leukocytosis reliable signs in vertebral osteomyelitis?
What is the most reliable sign?
No, fever and WBC count aren’t reliable
Tenderness to percussion over the vertebra
What is the treatment of immune thrombocytopenia?
How does treatment differ in children and adults?
IV Ig or glucocorticoids
In children, spontaneous recovery is likely so they should be OBSERVED if they only have cutaneous signs w/o evidence of bleeding.
Adults should be observed if platelets > 30K but should be treated if platelets are lower than that
What is the stepwise approach to treating ascites (4 steps)?
1) Sodium and water restriction
2) Spironolactone
3) Loop diuretic (i.e. furosemide)
4) Frequent abdominal paracentesis
