UWORLD facts Flashcards
What are anti-pseudomonal antibiotics?
zosyn, cefepime, ceftazidime, imipenem, amikacin, gentamicin, tobramycin, meropenem, ciprofloxacin, aztreonam, colistin
What is hungry bone syndrome? What is the timeline following parathyroidectomy?
Hungry bone syndrome is caused by the sudden withdrawal of parathyroid hormone in patients with severe hyperparathyroidism. This “relative” hypoparathyroidism causes an influx of calcium from the circulation into the bone. The serum calcium falls to its nadir between TWO TO FOUR DAYS after parathyroidectomy.
What is the characteristic finding on manometry for esophageal scleroderma? How is it different from achalasia?
absence of peristaltic waves in the lower two-thirds of the esophagus and a significant decrease in LES tone
In achalasia, there is an absence of waves but an INCREASED LES tone
Smoking cessation at of age 60 or older has been shown to lower the risk of all-cause mortality and cardiovascular events within ___ years of quitting.
After how long does cessation reverse the loss of bone density and decrease the risk of osteoporotic fracture?
within 5 years = decrease all cause mortality (but it will be less absolute decline than at younger ages).
10 years for bone loss
What are the treatments for ADHD? How long is an adequate trial at max dose? What is the tapering schedule when you switch?
methylphenidates (amphetamine), atomoxetine (NE reuptake inhibitor), clonidine (alpha2 adrenergic agonist)
Stimulant doses are titrated up weekly until max dose; for a couple weeks.
No need to taper or washout; can switch immediately
What is the difference between conjunctivitis and keratitis?
conjunctivitis is inflammation of the thin conjunctival membrane overlying the cornea, whereas keratitis is inflammation of the cornea. This complication is more common in patients with contact lenses. Patients with keratitis typically have a foreign body sensation (vs the grittiness that patients with conjunctivitis describe).
Keratitis also has photophobia and corenal opacity or ulcereration.
How is keratitis different from enophthalmitits?
Endophthalmitis involves the cornea but also deepr components of the eye including the vitreous and aqueous humors. It is usually acquired through an open wound to the eye or a systemic route, and not through conjunctivitis.
Viral conjunctivitis, often caused by ______, frequently has other systemic manifestations such as fever, pharyngitis, and upper respiratory symptoms.
Adenovirus
What are the most common causes of bacterial conjunctivitis? What is the treatment?
staph, strep pneumo, moraxella catarrhalis, and H flu.
Treat with erythromicin ointment, sulfa drops, or polymyxin/trimethoprim drops.
In contact lens wearers, use fluorquinolone drops (ciprofloxacin or ofloxacin) because pseudomonas is more common in those patients
How does cyclosporin cause gout?
decreases urate excretion from the kidneys causing hyperuricemia
What are the large coin-like particles you might see on joint aspiration (esp the shoulder joint)?
calcium phosphate crystals (“Milwaukee shoulder”)
Allopurinol decreases the activity of xanthine oxidase, which is responsible for the metabolism of which med?
azathioprine
Renal transplant patients should have gout treated by
systemic or intraarticular steroids (NSAIDs can reduce renal blood flow w/ cylosporin; colchicine with azathioprine can cause leukopenia)
Who are thei gh-risk cardiac disease patients who should have an assessment prior to advising on activity (like sex) after MI.
1) refractory angina
2) NYHA class IV heart failure
3) significant arrhythmias
4) severe valvular disease
Who are the high risk patients with mechanical valves who need a target INR of 2.5-3.5?
1) mitral mechanical valve
2) aortic with high risk features including afib
3) LV dysfunction (EF
What complication of lead poisoning are children at greatest risk of developing?
cognitivie impairment (then constipation and hemolytic anemia
What are the 3 thyroid-related syndromes related to amiodarone and how are they treated?
1) decreased peripheral conversion of T4 to T3 (high T4, lower T3, normal to mildly elevated TSH). Do nothing, retest in a few months
2) high iodine content may inhibit thyroid hormone synthesis (Wolf-Chaikoff). Hypothyroidism (TSH high and T4 low) . Treated with levothyroxine.
3) Amiodarone-induced thyrotoxicosis, either due to increased TH synthesis (type 1, treated with antithyroid drugs) or destructive thyroiditis (type 2;treated with glucocorticoids). In both cases, TSH low, and T3/T4 high.
What is a Colles fracture? What are injuries associated with this injury?
common in FOOSH
distal radius fracture with shortening and dorsal displacement. Significant displacement (>15=20 degrees) requires urgent ortho consult
Common associated injuries include ulnar styloid fracture, scaphoid fracture, and acute carpal tunnel syndrome.
What is the definition of massive hemoptysis?
600 mL over 24 hours. Bronchoscopy or angiographi embolizations should be considered in these cases.
What are the risks to the fetus from maternal diabetes?
macrosomia, hypocalcemia, hypoglycemia, hyperviscosity due to polycythemia, respiratory difficulties, and cardiomyopathy/CHF (excess glycogen deposition within the myocardium leads to hypertrophy of the interventricular septum)
What is the treatment of oncyhomycosis?
If KOH exam is positive, treat with terbinafine and itraconazole
Fingernails takes 6 weeks, toenails 12 weeks
What is the treatment for chlamydia infections?
azithromycin (1 gm as single dose) or doxycycline (100 mg PO BID for 7 days).
In pregnant women, erythromycin base or amoxicillin.
What adverse effect is associated with indinavir? What type of med is indinavir?
crystal-induced neppropathy
indinavir is a protease inhibitor
What adverse effect is associated with didanosine? What type of med is didanosine?
pancreatitis
NRTI
What adverse effect is associated with abacavir? What type of med is abacavir?
hypersensitivity syndrome
NRTI
What adverse effect is associated with the NRTIs? What are the NRTIs?
lactic acidosis
NRTIs include: abacavir, didanosine, lamivudine, zidovudine (AZT), emcitritabine
What adverse effect is associated with the NNRTIs? What are the NNRTIs?
Stevens-Johnson syndrome
NNRTIs include: efavirenz, nevirapine, delavirdine, etravirine, etc
What adverse effect is associated with nevirapine? What type of med is nevirapine?
liver failure
NNRTI
A high intensity statin should be started in anyone with LDL over
190 mg/dL
What meds should someone with PAD be on?
statin, antiplatelet therapy with aspirin or clopidogrel, BP control, and screening and treatment of diabetes
Diarrhea, cramping, abdominal pain, postprandial n/v, dizziness, sweating, and SOB after a partial gastrectomy think…
dumping syndrome!
Treat with high protein diet and fractionated, smaller, and more frequent food portions
What is the treatment escalation for CTS?
1) nighttime splinting (equally efficacious to full time splinting). Best in patients for sx less than 10 months
2) injected, or less preferably oral, steroids if pt does not improve
3) surgery for those who failed conservative management
