UWORLD facts 3 Flashcards
The displacement of otoliths in the semicircular canals is known as ____________. How is it treated?
BPPV. Treated wit hteh EPley maneuver (head positioning exercises)
What kind of vertigo can antihistamiens and phenothiazines (promethazine, prochlorpremazine) treat?
acute vertigo (not chronic)
A child with intestinal obstruction and failure ot pass stool for 48 hours, with explosive expulsion of gas and stool with rectal examination, suggests _________
How do you confirm the diagnosis?
Hirschsprung’s Disease (HD). Confirmed with rectal suction biopsy
Acute onset of fever and RUQ pain after colitis think:
Entamoeba histolytica (abscesses most often found in R hepatic lobe; contain accelular proteinaceous material (anchovy paste)). Treated with flagyl or chloroquine
Symptoms of a UTI WITH perineal pain or obstructive symptoms (like weak urinary stream) =
How do you treat?
acute prostatitis.
Treat with bactrim or fluoroquinolone
How do you differentiate between a coin in the esophagus or trachea on Xray?
If in esophagus, will appear linear on LATERAL xray
If in trachea, will appear linear on PA view
When can patients with coin ingestion be observed?
if they are asymptomatic and the coin ingestion occurred wtihin 24 hours. REpeat xrays should be obtained in 12-24 hours to make sure it has passed
When is surgery indicated for AAA?
1) If diameter reaches or exceeds 5.5cm
2) if it has grown more than 0.5 cm over a 6 month period
otherwise observe every 6 months if > 5, every year if >4.0, and every 2 years if >3
What is the criteria for surgery for hyperparathyroidism?
1) serum Ca greater than 1.0 above normal; 2) reduced Cr Cl 400; 5) nephrolithiasis or nephrocalcinosis; 6) age
What should spiral femur fractures make you think of?
child abuse. Requires spica cast
How can you differentiate ulcers due to neuropathy vs due to arterial insufficiency based on placement?
neuropathy = pressure points
arterial insufficiency = distal extremities (tips of toes); LATERAL malleolus (media = venous insuffiency)
What are the high intensity statins and who should be placed on them?
High-intesntiy statins include artova 40-80 and rosuvastatin 20-40.
Those with clinically significant atherosclerotic disease AND 75 or younger; those with LDL >190; and those with ASCVD risk 7.5% or greater with diabetes at least age 40.
Clinically significant atherosclerotic disease and OLDER than 75 or 40-75 with diabetes but ASCVD risk
What is the most common cause of erythema multiforme?
HSV. Targetoid lesions!
Why is prior uterine surgery (like a C section) a risk factor for retained products of conception?
it can lead to abnormal placentation (like placental attachment to the uterus; when the placenta invaseds the uterine wall over the area of ap rior scar, it is referred to as placenta accreta
What hormone is elevated in40% of patients with HCC?
AFP
HCC arises from hepatocytes
Where do the most common benign tumors of the liver arise from?
blood vessels! Cavernous hemangiomas
T/F: radical prostatectomy results in improved survival compared to radiotherapy for prostate cancer.
FALSE. Unclear if any difference in survival or complications. Radiation therapy has a lower frequency of post-treatment urinary incontience but a higher incidence of bowel dysfunction (compared to prostatectomy)
How do you treat pertussis?
erythromycin for patient and all close contacts (regardless of immunization status)
Bilateral reticular and linear opacitices predominantly affecting the upper lungs:
granulomatous lung disease
Primarily peripheral and basal reticular opacities with honeycombing:
Usual interstitail pneumonitis (pathologic manifestion of IPF)
T/F: Inguinal hernias shoudl be corrected in all children promptly.
True! (doesn’t seem to be age limit)
Who should get the herpes zoster vaccine?
Immunocompetent individuals over age 60 (should not be given to patients with immunodeficiency, AIDS, or those receiving immunosuppressive therapy)
What is the strongest risk factor for age-related macular degeneration?
smoking
What does a malignant pleural effusion in a patient with lung cancer mean?
Very poor prognosis; median survival of only four months, stage IV. Manage with palliation = obliteration of the pleural space
Between which lead levels should children be treated with DMSA?
moderate = levels 45-69
Between which levels should children be treated with EDTA?
If 70 or over, children should be treated with parenteral dimercaprol and EDTA
When should patients with PCP be treated with O2?
If PaO2 less than 70 or AA gradient greater than 35
When syould a patient get Xrays of the ankle?
1) pain near the malleoli
2) bony tenderness at the malleoli; OR
inability to bear weight
If S3 represents rapid ventricular filling, what does S4 mean?
atrial contraction (it represents left ventricular hypertrophy as it is caused by a stiff LV)
What are the indications for ICD therapy?
Primary: prior MI and LVEF ≤ 35% class I, less than 30% class II or III; sudden VF with unexplained cause. Structural disease and VT
What is the indication for cardiac resynchronization therapy?
patients in sinus rhythm with LVEF ≤35 percent, LBBB and a QRS duration ≥150 ms, and New York Heart Association (NYHA) functional class II, III, or ambulatory class IV symptoms with optimal medical therapy
What is the most common cause of inherited thrombophilia?
Factor V Leiden (which results in a resistance to the antithrombotic effects of protein C)
What is the difference between a delusional disorder about an illness vs illness anxiety disorder (hypochondriasis)?
in hyperchondriasis, these patients do not have rigidly fixed delusions: they can acknowledge the possibility they do not have the feared illness
What is normal transferrin saturation?
20-50% (in kids >16%)
When do NTDs occur?
during the 5 and 6 weeks of gestation, when the neural tube usually closes
In an NTD, what would the results of a quad screen show?
elevated afp, but nrmal hcg, estriol, and inhibin
What are the results of a quad screen in down syndrome?
elevated hcg and inhibin, low afb and estriol
What genus of virus is the BK virus?
polyoma virus (dsDNA)
Macrosomia is birthweight over _____ g
4500
T/F: Patients with nephrotic syndrome are prone to opportunistic infectoin.
False! They are at increased risk for infection, but moreso those caused by typical organisms like pneumococcus (not opportunistic)
What meds should be started in someone with NSTEMI?
aspirin, morphine, nitro, oxygen, beta blockers, statins, ACEI
There is some evidence that the atypical antipsychotic olanzapine may be helpful in patients with which ED?
anorexia
Which psych meds are used in treatment of BN?
antidepressants (particularly fluoxetine)
What is the preferred treatment of vulvovaginal candidiasis IN pregnancy?
intravaginal clotrimazole, miconazole or nystatin
single dose oral fluconazole is preferred in nonpregnant
How is indomethacin used in pregnancy?
tocolysis
How do you use urine to distinguish between potential causes of metabolic alkalosis with hypokalemia?
Urine chloride!
Patients with gastric losses (like vomiting) needto reabsorb chlorine (low urinary chloride).
But diuretic use or Gtielman/Bartters syndromes lead to high urine chloride
T/F: In metabolic alkalosis, there is a low FeNA.
False! The kidney’s need to excrete excess bicarb requires concurrent loss of sodium through the urine
Which med is used to treat depression in demntia nad post-stroke?
citalopram
What is the difference between a cohort study and a case-control study?
Cohort is prospective (can use RR), case-control is retrospective (use OR)
T/F: Treatment with ifn-alpha and ribavirin for HepC is contraindicated in patients with symptoms of depression.
True. Those meds have been shown to worsen depression and increase the rate of suicide
What is the most dangerous complication of GPA (Wegener’s)?
diffuse alveolar hemorrhage
How is PSC diagnosed?
MRCP or endoscopic cholangiography (shows multifocal areas of stricture and dilatation of intra- and extrahepatic bile ducts)
**anti-neutrophil cytoplasmic antibodies or anti-smooth muscle antibodies (but the latter is seen in autoimmune hepatitis)
How can you distinguish between viral and allergic conjunctivitis?
allergic is bilateral, while viral is unilateral (viral is also associated with gritty or sandy sensation)
Whe nis a figure-of-eight brace used vs sling?
sling = nondisplaced cervical fracture
figure of 8 = displaced cervical fracture
How do you start treating OA?
acetaminophen and heat. If that does’t work, try NSAIDS. If that doesn’t work, intraarticular steroids
What is Albright hereditary osteodystrophy?
Type 1a Psuedohypoparathyroidism (resistance of PTH on its target tissue). Short stature, round facies, short fourth and fifth metacarpals, short neck. Hypocalcemia with hyperphosphatemia (bilateral cataracts and calcification of basal ganglia and elevated PTH levels).
**OF NOTE, pseudopseudohypoparathyroidism is the features of Albright hereditary osteodystrophy without hypocalcemia nad hyperphosphatemia (because resistance to PTH is mild).
A garlic-like odor is associated with which overdose?
organophosphate poisoning (measure RBC acetylcholinesterase activity to gauge toxicity)
In infants with mild cyanosis at birth who develop progressive respiratory distress and shock a few days later, think:
hypoplastic left heart syndrome (dependent on open PDA)
What is complex regional pain syndrome?
How is it diagnosed?
pain out of proportion to an injury, temp change, edema, and abnormal skin color.
Diagnosis via autonomic testing measuring increased resting sweat output or MRI looking for skin thickening, muscle wasting, bone mineralization on Xray
Which increases the PPV of a test, specificity or sensitivity?
higher Sp = higher PPV
higher Sn = higher NPV
When are preoperative PFTs recommended?
1) prior to lung resection to estimate postop lung values
2) to optimize preoperative COPD if baseline clinical status cannot be determined
3) to evaluate cause of dyspnea or exercise intolerance (needs to complete at least 4 mets = climb flight of stairs, good functional status)
Smoking cessation at least __ weeks prior to surgery decreases the risk of postoperative pulmonary complications.
4
What is the formula for positive LR?
sensitivity / (1 - specificity)
What is the formula for negative LR?
(1 - sensitivity) / specificity
What is contamination bias?
when the control group unintentionally receives the treatment/intervention
What is susceptibility bias? How is different from selection bias?
Susceptibility bias is a TYPE of selection bias where experiemental and control groups differ from a prognostic standpoint (possibly due to confounding variables). Selection bias is the manner in which study participants are selected or lost to follow-up
What is Wallenberg syndrome?
What causes it?
Wallenberg = lateral medullary infarct.
Loss of pain and temperature over the ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vestibulocerebellar impairment (eg vertigo, nystagmus, ipsilateral limb ataxia=overshooting), and Horner’s syndrome. Motor function is spared, typically.
Caused by occlusion of the posterior inferior cerebellar or vertebral artery
How do you distinguish between lateral mid-pontine lesions and lateral medullary lesions?
Lateral mid-pontine lesions affect MOTOR and principal sensory nuclei of ipsilateral trigeminal nerve (weakness of mastication, diminished jaw jerk, impaired tactile and position sensation).
Lateral medulla = CN IX and X involvement (dysphagia, hoarsenss, diminished gag reflex)
What are causes of microcephaly in infants?
TORCH infections
toxo, rubella, CMV, herpes, other (syphilis, VZV, parvo
What is tinea manuum?
fungal infection (typicaly of one hand). Annular erythema with a trailing scale on dorsal or ventral hands
Patients with narcolepsy have (more/less) REM sleep latency and (more/less) hypocretin-1 in the CSF
less REM sleep latency
less hypocretin-1 in the CSF
What is firstline treatment for narcolepsy?
modafinil
What is the treatment of cataplexy (sudden muscle weakness, often triggered by intense emotional episodes)?
cataplexy is a symptom of narcolepsy. Can be treated with SNRIs (ie venlafaxine) or SSRI; TCAs can also be considered.
How do you diagnose MS on T2 MRI?
ovoid-shaped periventricular white matter lesions
Oral and IV steroids are equally efficacious in treating acute MS except when…
patient has optic neuritis (oral steroids can increase recurrent optic neuritis)
What is chronic maintenance therapy for MS?
beta-interferon; glatiramer acetate
What is the treatment for early latent vs late latent syphylis?
early latent withi n12 months = 1 shot benzathine pencillin. Late latent = weekly for 3 weeks
What is the Jarisch-Herxheimer reaction?
an acute febrile reaction within 24 hours of initiation of treatment for a spirochetal infection (syphysilis, leptospirosis, tick-borne spirochetes)
No treatment/prevention
WHat is the duration of warfarin treatment in patient with first DVT? recurrent DVT?
first: 3-6 months
recurrent: lifelong
T/F: Tamoxifen also confers a risk of increased VTE.
True
Cervical insufficiency = cervical length
cervical length of less than 25 mm at or before 24 weeks of gestational age
What are risk factors for cervical insufficiency?
collagen abnormalitties (like ehlers danlos), uterine anomalies (septate/bicornuate uterus), prior obstetric trauma (cervical laceration from delivery), mechanical cervical dilation (D&C, pregnancy termination), and LEEP/conization
What is Nelson’s ysndrome?
pituitary enlargement (visual field defects) and hyperpigmentation following bilateral adrenalectomy for Cushing’s disease
Which health care workers need prophylactic antibiotics for Neisseria meningitidis?
if directly exposed to respiratory secretions (mouth to mouth resuscitation, ET intubation)
WHat is the ppx for prophylaxis against N. meningitidis and when should it be given?
1) rifampin (600mg BID x2d; NOT in OCP users, as it increases their clearance/limits their efficacy)
2) cipro 500mg single
3) ceftriaxone
What is the treatment for metoclopramide-induced acute dystonia?
diphenhydramine IV
How do you confirm the clinical diagnosis of LP?
punch biopsy of most prominent lesions
What is the screening test for pheochromocytoma?
measure PLASMA FREE METANEPHRINE or a 24-HOUR URINE COLLECTION FOR MEASUREMENT OF CATECHOLAMINE AND METANEPHRINE
(24-hour VMA excretion has a much lower sensitivity and specificity)
When is a MIBG performed in patients with suspected pheo?
When tumors are >5cm diameter (more likely to have extra=adrenal disease) OR when MRI is negative but still suspicious for pheo
How do you treat hypertensive crisis in adrenalectomy for pheo?
IV nitroprusside, phentolamine, or nicardipine
How do you treat cardiac tachyarrhythmias during/after adrenalectomy for pheo?
it’s due to increased catecholamine release. Treat with IV lidocaine or esmolol
An elevated alk phos with normal Ca and no concurrent hepatobiliary disease may suggest
Paget diseas
T/F: Treating people with Paget’s disease with calcitonin or bisphosphonates can reverse hearing loss.
FALSE
Though it can slow the progression of hearing loss, it is unlikely to reverse hearing loss that has already occurred
The treatment for acute hepatitis B is usually just supportive, unless…
patient has concurrent hep C, immunosuppression, or severe disease/fulminant hepatic failure. Lamivudine can be used for those with impaired synthetic function (ie PT elevations) or those with underlying immunosuppression)
T/F: Patients with severe acute hep B and C are more likely to develop chronic hepatitis.
FALSE!!! opposite
In an infant with diaphragmatic paralysis, look for
Erb’s palsy
In RLS, what lab should you obtain?
ferritin. RLS may be a sign of IDA
How do you distinguish between IgA nephropathy and thin membrane disease?
hematuria in thin membrane disease is unrelated to URI. Can use biopsy to tell the difference
When do you diagnose a male patient with delayed puberty?
if no testicular enlargement by 14; or if testicles are 2.5 cm or less in diameter.
OR Delay of development for 5 years or more from onset of genitalia enlargement
When do you diagnose a female patient with delayed puberty?
1) absence of breast development by age 13
2) a time lapse of more than 5 years between breast development and menarche
3) no menarche by age 16
What is Foster-Kennedy syndrome?
optic atrophy on the side of the tumor in the frontal lobe with papilledema on the contralateral side
What type of tumors can cause precocious puberty in prepubertal males and visual difficulties?
pineal tumors; are germinomas that can secrete HCG
What causes wide and flixed splitting of the second heart sound?
ASDs
Porphyria cutanea tarda is a condition that arises from deficiency of (which enzyme) and is triggered by the ingestion of certain things, including _______
deficiency of uroporphyrinogen decarboxylase. Associated with ingestion of ethanol, estrogens, which should be discontinued if suspect. Often als oassociated with Hep C virus (in which case ifn-a can cause relief). Phelobotomy or Hydroxychloroquine can also provide relief.
What is the treatment for lymphocutaneous sporotrichosis?
Itraconazole for 3-6 months
In ARDS, the goal plateau pressure is
less than 30
Permissive hypercapnia is safe for most patients, except
those with elevated ICP or a seizure disorder
What are the two main causes of MAT?
hypoxia, COPD (also could be hypokalemia, hypomagnesemia)
Treatment of MAT in patients with asthma or COPD:
verapamil
