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UWORLD Journal > UWORLD JOURNAL > Flashcards

UWORLD JOURNAL Flashcards

1
Q

Patient develops dark colored urine, scleral icterus, and pale lips following treatment with Dapsone. Hg is 8.5. UA shows moderate amount of blood. What is the mechanism for urinary findings?

A

Oxidative injury.

He has G6PD deficiency.

Erythrocytes are unable to generate sufficient NADPH to counter oxidative injury –> hemolytic anemia.

UA showed false positive for blood due to heme in the urine excreted by kidneys.

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2
Q

What are the causes of hemolytic anemia in G6PD deficiency?

A

Medications

  • Dapsone
  • TMP-SMX
  • Primaquine
  • Chloroquine
  • Nitrofurantoin
  • Isoniazid
  • NSAIDS
  • Ciprofloxacin
  • Chloramphenicol

Food
-Fava Beans

Infection

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3
Q

What is the inheritance pattern for G6PD Deficiency?

A

X linked recessive

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4
Q

What does a blood smear show in G6PD deficiency?

A

Heinz bodies and Bite cells

Signs of intravascular hemolysis

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5
Q

What are the signs of intravascular hemolysis?

A 
Normocytic anemia
Inc retic count
Inc Unconj bili
Inc LDH
Dec Haptoglobin
Hemoglobinuria
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6
Q

Antibody mediated hemolsis is seen with which disease process?

A

Warm or cold agglutinin disease.

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7
Q

Complement activation is associated with which disease that causes microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure?

A

Hemolytic uremic syndrome

UA shows hematuria and proteinuria.

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8
Q

Immune complex deposition causes ____ glomerulonephritis, leading to hematuria with dysmorphic RBCs on UA.

A

Membranous

Most cases caused by chronic infection (Hep B or C), rheumatic disease (SLE), or monoclonal gammopathy (multiple myeloma).

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9
Q

Interstitial leukocyte infiltration is seen in ____ in which the UA shows erythrocytes, leukocytes, and white cell casts. Pt typically has rash, fever, and peripheral eosinophilia

A

Acute interstitial nephritis.

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10
Q

What is the “ugly duckling” sign for melanoma and how sensitive is it?

A

It’s a lesion that appears substantially different from the others.

Up to 90%

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11
Q

What is the most important prognostic indicator in malignant melanoma?

A

Breslow depth

-Distance from the epidermal granular cell layer to the deepest visible melanoma cells

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12
Q

Should you biopsy skin lesions that itch or bleed?

A

yes, particularly with other concerning features

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13
Q

What type of biopsy should be done if melanoma is suspected?

A

Excisional with initial margins of 1-3mm

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14
Q

What medications have been shown to improve survival in LV systolic heart failure?

A

ACEi

ARBs

BetaBlockers

Mineralocorticoid receptor antagonists

  • spironolactone
  • eplerenone

In African American pts combination of hydralazine and nitrates

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15
Q

Pt with A fib/HF with diarrhea, nausea, dec appetite, confusion, and /or fatigue consider ____.

A

Digoxin toxicity

Can also have visual changes.

Viral illness or diuretic use can lead to volume depletion or renal injury that acutely elevates digoxin level.

Hypokalemia, often associated with loop diuretic use can inc pts susceptibility to toxic effects of digoxin.

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16
Q

What serious adverse effect can occur with long term Amiodarone use?

A

Interstitial Pulmonary Fibrosis

A baseline chest radiograph and PFT should be done prior to initiating Amiodarone

17
Q

What are the common causes of hypogonadism in Men? Primary (4). Secondary (2). Combined (2).

A

Primary

  1. Congenital (Klinefelter syndrome, cryptorchidism)
  2. Drugs (alkylating agents, ketoconazole)
  3. Orchtis (mumps), trauma, torsion.
  4. Chronic Kidney Disease

Secondary

  1. Gonadotroph damage: Tumor, cranial trauma, infiltrative diseases like hemochromatosis, apoplexy.
  2. Gonadotropin suppression: Exogenous androgens, hyperprolactinemia, diabetes mellitus, morbid obesity

Combined

  1. Hypercortisolism
  2. Cirrhosis
18
Q

What are the risk factors for squamous cell carcinoma of the skin?

A

UV, ionizing radiation

Immunosuppression

Chronic scars, wounds, burn injuries

19
Q

What are the clinical features of squamous cell carcinoma of the skin?

A

Scaly plaques/nodules

+/- hyperkeratosis or ulceration

Neurologic signs with perineurial invasion

20
Q

How do you diagnose squamous cell carcinoma of the skin?

A

Biopsy shows dysplastic/anaplastic keratinocytes

21
Q

What is the treatment for SCC of the skin?

A

Small or low risk lesions: surgical excision or local destruction

High risk or cosmetically sensitive areas: Mohs micrographic surgery

22
Q

What is it called when SCC of skin arises in a wound or burn?

A

Marjolin ulcer and it is associated with inc risk of metastasis.

23
Q

What is the first line treatment for acne?

A

Topical retinoids

24
Q

What is Beck’s Triad for cardiac tamponade?

A
  1. Hypotension
  2. Distended neck veins
  3. Muffled heart sounds

Pulsus Paradoxus is also a common finding (>10 mmHg drop in SBP during inspiration)

25
Q

Cardiac tamponade restricts venous return to the heart –> what change in preload, stroke volume, CO?

A

Decreases all three

26
Q

MEN Type 1 includes?

A
  1. Primary hyperparathyroidism (Parathyroid adenomas or hyperplasia)
  2. Pituitary tumors (prolactin, visual defects)
  3. Pancreatic tumors (esp gastrinomas)
27
Q

MEN Type 2A includes?

A
  1. Medullary thyroid cancer (calcitonin)
  2. Pheochromocytoma
  3. Primary hyperparathyroidism
28
Q

MEN Type 2B includes?

A
  1. Medullary thyroid cancer (calcitonin)
  2. Pheochromocytoma
  3. Mucosal neuromas/marfanoid habitus
29
Q

Water hammer or bounding pulse is associated with which heart murmur?

A

Aortic regurgitate

30
Q

What defect and murmur are associated with fixed splitting of S2?

A

ASD, mid systolic pulmonary flow murmur

31
Q

Pulsus parvus and tradus are associated with which heart murmur?

A

Aortic stenosis

32
Q

What is responsible for Chagas disease?

A

Protozoan Trypanosoma cruzi

33
Q

Plantar warts are due to _____ and most commonly affect ___ or ___ individuals

A

HPV
Young adults
Immunocompromised

34
Q

Initial evaluation for HTN includes:

A

UA
Chemistry panel
Lipid profile
baseline electrocardiogram

35
Q

Erysipelas:
Organism?
Manifests?

A

Strep Pyogenes

  • Superficial vermis and lymphatics
  • Raised, sharply demarcated edges
  • Rapid spread and onset
  • fever early in the course
36
Q

Cellulitis (non purulent)
Organism?
Manifests?

A

Strep pyogenes, MSSA

  • Deep dermis & subcutaneous fat
  • Flat edges with poor demarcation
  • Indolent
  • Localized
  • fever later in course
37
Q

Cellulitis (purulent)
Organism?
Manifests?

A

MSSA, MRSA

  • purulent drainage
  • Folliculitis: infected hair follicle
  • farunculitis: folliculitis –>dermis –> abscess
  • carbuncle: multiple furuncles

UWORLD Journal (1 decks)

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