UWorld Medicine Flashcards
Complications of acute pancreatitis
Effusion, ileus, pseudocyst, abscess, necrosis, renal failure, ARDS
Immediate treatment for CRAO/amarousis fugax
Ocular massage, high flow oxygen
Treatment for Prinzmetal’s angina
Cardizem
Kaposi’s sarcoma is caused by
HHV-8
Ventricular arrhythmias 2/2 AMI Type IA vs IB
1A: re-entrant
1B: abnormal automaticity
HBV treatment indicated when… Treat with…
Cirrhosis, CTX/IS, acute liver failure. Tenofovir
Tinnitus, hearing loss, acoustic neuroma, cafe-au-lait spots
NF
Which fungal infection mimics sarcoid?
Histoplasmosis
NC granulomas are characteristic of which fungal infection?
Histoplasmosis
The 2 fungal infections that mimic TB
Histo-cough/nodosum/NC gran; and Blasto
Blasto: skin lesions, osteolytic, prostate
This fungal infection is endemic to SW USA.
Coccidocymycosis
What types of screening should be performed in patients with compensated cirrhosis?
U/S, EGD, AFP q 6 months
Medical therapy for variceal hemorrhage
Beta blockers
Treatment for ascites
Paracentesis, Na restriction
Oligoclonal bands in CSF
MS
Albuminocytologic dissociation in CSF
GBS
Decreased FEV1:FVC
Obstructive lung disease; decreased DLCO: COPD vs . non-decreased=asthma
Normal FEV1:FVC
Restrictive lung disease; Decreased DLCO: ILD vs. non-decreased: OHS, MG, ALS, chest wall
Winter’s formula
Determines appropriate respiratory compensation
PaCO2 = (1.5 x HCO3) + 8 +/-2
Polyarthralgias, tenosynovitis, vesiculopustular lesions
Disseminated gonococcal infection
Erythema migrans
Lyme
What type of rash in disseminated meningococcal infection/
Petechial
The major blood transfusion reactions
Immediate: IgA, anaphylactic
1-hour: Acute hemolytic 2/2 ABOi, fever/flank/DIC
Urticarial: 2-3 hours, IgE
Febrile: 1-6 houts 2/2 WBC releasing cytokines (leukocyte reduced)
2-10 days: Delayed hemolytic; anamestic Ab/sensitized
ALI: donor anti-leukocyte Ab; respiratory distress
Which nephrotic syndrome a/w AA’s, HIV, heroin?
FSGS
Which nephrotic syndrome a/w HBV?
MN
Differentiate between 2 types of esophageal ca.
Adenoca: GE junction 2/2 Barrett’s
Squamous: Anywhere, smoking/EtOH
Low risk vs high risk for esophageal cancer studies
Low risk: Barium esophagram
High risk: Endoscopy
Initial treatment of a prolactinoma with no visual symptoms.
Cabergoline, bromocriptine
Beck’s triad
Hypotension, JVD, muffled heart sounds
Pulsus paradoxus
Decrease in SBP by 10 with inspiration
Leukemoid reaction vs. CML
L: 50,000, high LAP
CM: 100,000 bcr-abl; basophilia
Most ideal treatment for HTN
Weight loss
Live attenuated vaccines
MMR, VZV, Yellow fever, IN influenza, Oral polio, Rota
Klinefelter has high or low FSH/LH
High
What combination of drugs can be used to correct K abnormalities in treatment of CHF?
Lasix, ACEi
Anti-topoisomerase Ab
Scleroderma
Anti-mitochondrial Ab
PBC
Anti-smooth muscle Ab
AI hepatitis
What is ichthytosis
Dry and rough skin with horny plates on the limbs
CYP Inducers
Phenobarbital, Carbamzepine, Rifampin, OCP, Ginsing, St. Johns
CYP Inhibitors
Tyl, Flagyl, NSAIDS, Amiodarione, Cranbery, SSSI, Omeprazole
What drug relieves symptoms of diffuse esophageal spasm?
NG
Where is angiotensinogen made?
Liver
Why should you avoid NSAID’s in acute kidney injury?
PG’s help dilate the afferent arteriole
Pulmonary hypertension in obesity hypoventilation syndrome is 2/2
Hypoxic vasoconstriction
Major potential adverse effect of PTU/Methimazole
Agranulocytosis
Broca’s aphasia vs. Wenicke’s aphasia
Broca’s: Expressive
Wernicke’s: Comprehension
Greatest risk factor for CVA
Hypertension
What converts angiotensinogen into A1?
Renin
Where is ACE enzyme located?
Lung
What infection is common to gardeners?
Sporothrix
Hepatic hydrothorax can lead to R or L effusion?
R
Do you need a contrast CT for nephrolithiasis?
No
Does lupus anti-coagulant leads to increased or decreased PTT?
Increased
What is d-dimer
It is cross-linking fibrin, when the clot dissolves, d-dimer goes up
A potential complication of mono, besides splenic rupture.
AIHA (Cold, IgM)
How do you treat severe uremic pericarditis?
Dialysis
Long-term use of NSAIDS can lead to…
Peptic ulcers
What is the FDA approved drug to use in cancer cachexia?
Progesterone analogues: megestrol
For what is Marinol approved?
AIDS wasting
Does hyper or hypothyroid predispose to carpal tunnel syndrome?
Hypothyroid
Differentiate Mobitz 1 vs 2
1: Increasingly long PR interval –> dropped
2: Dropped QRS every x-time
What skin findings is a/w glucagonoma?
Necrolytic migratory erythema
Differentiate Boerheave from MW.
Boerheave: painful, perforation
Reactive arthritis
Can’t pee, see, climb a tree
What substance is indicated in hepato-renal syndrome?
NO; try to induce splanchnic vasoconstriction
HIT is 2/2
Conformational change of PF4 –> IgG platelet activation, thrombosis and thrombocytopenia
CMV ppx
Valgancyclovir
PCP ppx
Bactrim
Smudge cells are pathognomic for…
CLL
3 major AE’s of Amiodarone
TFT, LFT, PFT
Where is angiodysplasia most likely to be located in colon?
Right colon
Anti-glutamate decarboxylase Ab
DM1
Spontaneous bacterial peritonitis
Fever, AMS, abdominal pain
PMN’s > 250; +CX; Protein 1.1
T/F Angiodysplasia is a/w aortic stenosis
True; AS –> VW disease/renal disease
FAP is AD/AR. What is the colon cancer risk? When is total proctocolectomy indicated?
AD; risk is 100%; at the time of diagnosis
T/F Any patient with an acute, severe illness may have abnormal thyroid function tests
True
The pathogenesis of ACEi induced cough…
Increase in circulating inflammatory mediators: bradykinin, substance P, PG’s
Rapidly progrssive dementia, myoclonus, sharp, triphasic synchronus discharges on EEG
Creutzfeld-Jakob disease
Dementia caused by a defect in AD gene on ch 4
Huntington’s: striatal neuro-degeneration
Histopathological findings of neurfibrilary tangles and amyloid plaques
Alzheimer’s
Neurodegeneration of frontal and temporal lobes
Pick’s disease
Bitter almond breath indicates inhaled…
CN
This toxin, when inhaled, results in a pinkish-red skin hue
CO
This inhalation results in cyanosis and bluish discoloration of skin and mucus membranes
MethHgb
This syndrome is caused by excessive intake of Ca and absorable alkali
Milk Alkali Syndrome
Major effect of Angiotensin 2 in the renal artery…
Preferential vasoconstriction of the efferent arterioles, resulting in increased intra-glomerular pressure
A young obese female with headaches and shrunken ventricles…
Pseudotumor cerebri
Examples of first generation anti-histamines
Diphenhydramine, doxepin, hydroxyzine
T/F Acyclovir can result in crystal-induced kidney injury
True, along with sulfonamides, MTX, protease inhibitiors
The most common cause of isolated aortic regurg in young adults in developed countries… And in developing countries
Bicuspid aortic valve
- Rheumatic heart disease
Wide, fixed and split S2
ASD
Harsh creschendo-decrescendo systolic murmur at apex
HOCOM (Valsalva and standing decrease PL and increase intensity of murmur)
Treatment of stable VT (wide complex, fusion beats)
IV Amiodarone (procainamide, sotalol, lidocaine)
Treatment of paroxsysmal SVT
Carotid massage
Upper vs. lower lip; BCC vs. SCC
Basal cell: upper lip; SCC: lower lip
Most common cause of esophageal rupture
Endoscopy
What is the best study to demonstrate esophageal perforation?
Contrast esophagram with water soluble contrast (barium has higher sensitivity, but is second line)
Acute chest pain, subcutaenous emphysema, left-pleural effusion classically represents
Esophageal perforation
Major complication of pseudotumor cerebri
Blindness
The pathophysiology of pseudotumor cerebri
Impaired absorption of CSF by arachnoid villi
Medical treatment of pseudotumor cerebri
Weight reduction and acetazolamide
Surgical treatment of pseudotumor cerebri
Shunting or optic nerve sheath fenestration
Complications of pneumonia
Complicated parapneumonic effusions, empyema
Do complicated parapneumonic effusions have positive or negative pleural fluid gram stain?
Negative
This tick-borne illness is a/w leukopenia and thrombocytopenia, elevated LDH and transaminitis
Ehrlichia; treat with doxy (SE US)
CT scan after TBI that shows numerous minute punctate hemorrhages with blurring of grey-white interface
DAI
T/F Heterophile Ab can be negative early in the course of infectious mononucleosis
True
Common cause of false positive VDRL in pregnant women
Antiphospholipid antibody syndrome
Is Warfarin contraindicated in pregnancy?
Yes
Anti-thyroid peroxidase Ab
Hashimoto’s thyroiditis
This type of skin cancer arises from an enlargening nodule, and can display early perineural invasion
SCC
Which skin cancer is especially common in patients on chronic IS therapy?
SCC
The most popular treatment for hyperthyroidism in the USA
Radioactive I.
The greatest risk of developing hypothyroidism following radioactive I treatment is seen in patients with…
Graves disease
Contact-lens keratitis is usually secondary to…
Gram negative organisms, i.e Pseudomonas
In keratitis, is the cornea spared?
No. Whereas in conjunctivitis, it is spared
Pityriasis rosea vs. Pityriasis versicolor
Rosea: Xmas tree herald patch
Versicolor: Malassexia, hypopigmented, don’t tan
Spaghetti and meatball pattern on KOH
Pityriseas versicolor
Hashimoto’s thyroiditis can lead to…
Lymphoma of the thyroid
Thyroid cancer of C cell origin
MTC
Initial treatment of severe hypovolemic hypernatremia? What about less severe?
IV NS; less severe are treated with D51/2NS
Treatment for euvolemic/hypervolemic hypernatremia
D5W
Treatment of hypernatremia based on volume status
Hypovolemic-Severe: IV NS
Hypovolemic-Mild: D5 1/2 NS
Euvolemic/Hypervolemic: D5W
Anti-histone Ab
Drug-induced lupus
Anti-CCP
RA
Triad of inflammatory arthritis, splenomegaly and neutropenia
Felty syndrome (patients with long-standing RA)
What is the anion gap?
Na - (Cl+HCO3)
MGUS vs. Waldenstrom’s macroglobulimemia
MGUS: no end organ anemi, HSM, LAD, systemic symptoms
Overdose: hyperthermia, dilated pupils, intestinal ileus, QRS prolongation
TCA
QT prolongation 2/2 TDP is treated with
Mg
Overdose: Bradycardia, miosis, salivation
Cholingergic toxicity - treat with atropine
Crohn’s vs. UC: bloody diarrhea, pseudopolyps, non-rectal sparing, no skip lesions, mucosal/SM involvement, crypt absecess
UC
T/F Tick borne paralysis usually progresses over hours
True
Descending paralysis and CN involvment
Botulism
Rapidly progressive ascending paralysis (asymmetrical), absence of fever/sensory abnormalities, normal CSF
Tick-borne paralysis
* Remove the tick!
Trihexyphenidyl
Anti-cholinergic used in younger Parkinson’s patients for whom tremor is the predominant symptom
First-line treatment for essential tremor
Propranolol
Treatment of Warm AIHA
CS
Treatment of Cold AIHA
Rituxan
Butterfly appearance of a brain tumor
GBM
Treatment of Nocardia vs. Actinomyces
Nocardia: Bactrim
Actinomyces: PCN
Anaerobic, filamentous branching bcteria that colonizes the oral cavity
Actinomyces
Aerobic cs. Anaerobic: Nocardia/Actinomyces
Nocardia: Aerobic
Actinomyces: Anaerobic
Cervicofacial involvement in a diabetic patient undergoing dental procedure
Actinomyces
Describe how a patient with a PE can experience signs/symptoms of hypocalcemia.
Respiratory alkalosis results in albumin letting go of H+, and then it picks up Ca.
Three forms of Ca in the blood
Ionized (active), albumin, inorganic anions
TRAP+, CD11a+ leukemia
Hairy cell leukemia
Reed-Sterberg cells are characteristic of…
Hodgkin’s lymphoma
Vagal maneuvers can abolish PSVT by…
Decreasing AV nodal conductivity (also adenosine)
Activated charcoal within X hours of Tylenol ingestion
4
What is the toxic dose of Tylenol ingestion?
7.5 g
When do you I&D a stye?
After 48 hours of non-improvement with warm compresses
Bird-beak narrowing on barium swallow
Achalasia
Foul smelling sputum along with an indolent course of fever, malaise, cough
Aspiration pneumonia caused by anaerobes
Drug of choice for PCP pneumonia
Bactrim
3 options for anaerobic coverage from oral pathogens
Amoxicillin, Augmentin, Clinda
Diastolic decrescendo murmur with widened pulse pressure
Aortic regurgitation
Pulsus parvus and tardus
Aortic stenosis
Valve surgery is indicated in native valve bacterial endocarditis when…
Valvular dysfunction resulting in CHF, infection persistent or difficult to treat medically, recurrent septic embolization
Causes of microscopic hematuria
Renal (cancer, nephropathy), Ureteral (stricture, stone), bladder (cancer, cystitis), prostate/uretheral (BPH, prostate cancer, uretheritis)
Most important risk factor for bladder cancer
Cigarette smoking
Rectal sparing: UC or Crohn’s
Crohn’s
Intestinal complications of Crohn’s vs. UC
Crohn’s: Fistulas, strictures, abscesses
UC: Toxic megacolon
Crohn’s vs. UC: Absence of perianal abnormalities
UC
Crohn’s vs. UC: Continuous inflammation
UC
Crohn’s vs. UC: Bloody diarrhea
UC
Crohn’s vs. UC: Rectal inflammation
UC
Crohn’s vs. UC: Pseudopolyps
UC
Crohn’s vs. UC: NC granulomas
Crohn’s
Crohn’s vs. UC: Cobblestoning
Crohn’s
Reduced spermatogenesis, gynecomastia, mood disturbances, aggressive behavior
Androgen abuse
Immediate synchronized direct current cardioversion is indicated when patients p/w
Tachyarrhythmia causing hemodynamic instability (hypotension, shock, AMS, pulmonary edema)
A patient with RA with a soft, tender mass in the popliteal fossa
Baker’s cyst (2/2 excessive fluid production by inflamed synovium)
The hallmark of frostbite treatment
Rapid rewarming in a warm water bath
Overdose: dry as a bone, blind as a bat, hot as a hare, full as a flask
Anti-cholinergic
Hypotension, pigmentation, hyponatremia, hyperkalemia, eosinophilia, high ACTH, and low corisol
Primary adrenal insufficiency
Most common cause of primary adrenal insufficiency in developed countries
Autoimmune adrenalitis
Lambert-Eaton Syndrome is 2/2
Auto-antibodies to presynaptic membrane voltage-gated Ca channels: diminished or absent deep-tendon reflexes
Dematomyositis is a paraneoplastic syndrome resulting from
Muscle fiber injury
Gottron papules, heliotrope rash
Dermatomyositis
All patients with CRF and HCT
Fe deficiency
Most common AE’s of EPO therapy
Worsening of hypertension, headache, flu-like, red cell aplasia
Leading cause of ESRD in US
DM: glomerular hyperperfusion/hypertrophy; GBM thickening; microalbuminuria–> nephropathy
Bence-Jones proteinuria
MM
________________ common in travelers in tropical regions, characterized by pruritic, serpiginous lesions on the skin; contact with sand
Cutaneous larva migrans
Lateral chest leads
I, avL
Anterior chest leads
V1-V4
Inferior chest leads
2, 3, avF
Strongest predictor of cardiac stent thrombosis within 12 months
Premature discontinuation of (dual) anti-platelet therpay
T/F Tylenol potentiates the anticoagulant effect of Warfarin
True
What is prothrombin complex concentrate?
Kcentra’ contains vitamin K dependent clotting factors (2, 7, 9, 10)
To reverse Coumadin immediately
Kcentra, FFP, (Vitamin K)
Urgent reversal of heparin
Protamine sulfate
Pulmonary infection PLUS impaired bacterial clearance (obstruction of airway, impairment of drainage, defect in immune response)
Bronchiectasis
Lower lobe emphysema is c/w
Alpha-1-antitrypsin deficiency
Periodic febrile paroxysms coupled with nonspecific malaise, headache, n/v, abdominal pain, HSM
Malaria (Plasmodium falciparum)
First line treatment for Alzheimer’s
Cholinesterase inhibitors (donepezil, galantamine, rivastigmine)
Side effect of high-dose niacin for severe hypertriglyceridemia; how do you prevent it?
Cutaneous flushing and intensive generalized pruritis 2/2 peripheral vasodilation. Can be prevented with ASA
What is doxazosin? Caution should be used in prescribing this with what other drug?
Alpha-blocker; caution in Rx with Viagra
First line treatment for Giardia
Flagyl
Valsalva, abrupt standing, and NG effect on HOCM murmur
Increase intensity 2/2 decreased preload
Two most common mutations in HOCM
Cardiac myosin binding protein C gene; cardiac beta-myosin heavy chain gene
AE Methotrexate
Purine antimetabolite; hepatotoxicity, stomatitis, cytopenias
AE Leflunomide
Pyridine synthesis inhibitor; hepatotoxicity, cytopenias
AE Hydroxychloroquine
TNF/IL-1; Retinopathy
AE TNF inhibitiors: Adalimumab, Etanercept, Infliximab
Anti-cytokine agents; Infection, demylination, CHF, malignancy
The conversion of homocysteine to methionine requires
B12/Folate
To differentiate between folate or B12 deficiency, order the blood level of this substance
MMA
Most common primary immune deficiency
IgA deficiency
Patients with IgA deficiency p/w these 2 types of infection
Sinopulmonary, GI (Giardia)
Syndrome: recurrent sinopulmonary infections, eczema, thrombocytopenia
Wiskott-Aldrich
Symptoms of theophylline toxicity
CNS stimulation (ha, insomnia, seizures), GI disturbances, arrhythmia
Beta vs. Alpha thal geography
Beta: Mediterranean
Alpha: SE Asia
HIV: White plaques in esophagus
Candida
HIV: Large linear ulcers in esophagus (intranuclear and intracytoplasmic)
CMV/Gancyclovir
HIV: Vesicles; round; ovoid ulcers
HSV/Acyclovir
Mild oral thrush in HIV can be empirically treated with
Fluconazole
Scrombroid p/w
Flushing, urticria
Listeria p/w
meningitis
Ciguateriap/w
Paresthesia
On flow cytometry, absence of CD55 and CD59
PNH; these proteins normally inhibit the activation of complement
Treatment of PNH
Fe, Folate; Eculizumab (Mab that inhibits complement activation)
Hemolysis, Cytopenia, Portal Vein Thrombosis
PNH
Third most common cause of acute pancreatitis
Hypertriglyceridemia
Three most common causes of AS
- Bicuspid
- Senile plaques
- Rheumatic
