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UWorld Notes 1 Flashcards

1
Q

AIDS mass lesion in CNS. Dx? Treatment?

A

Toxo.

Tx: Sulfadiazine and pyrimethamine

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2
Q

Painful STD’s

A

Chancroid, HSV

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3
Q

School of fish appearance ulcers

A

Haemophilus ducreyi-chancroid

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4
Q

Granuloma inguinale

A

Klebsiella granulomatis;
ulceration w/o lymphadenopathy
Donovan bodies: deep staining gram - intracytoplasmic cysts

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5
Q

Lymphogranuloma venerum

A

Chlamydia Trachomatis
small shallow ulcers
-large inguinal nodes (buboes)

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6
Q

Bleeding cirrhotic. How to treat bleed?

A

FFP

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7
Q

Aztreonam good for what

A

G-; including pseudomonas

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8
Q

Polyarthralgias, tenosynovitis, vesiculopustular skin lesions. dx?

A

Gonococcemia

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9
Q

Initial management of Frost Bites

A
  1. Rewarm in water (only if can be managed without refreezing)
  2. consider debridement/thrombolytic therapy if needed
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10
Q

peripheral blood smear for sickle cell

A

sickle RBC, polychromasia, Howell Jolly body

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11
Q

Burr RBC cells

A

uremia/artifact

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12
Q

Pappenheimer bodies

A

Sideroblastic anemia

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13
Q

Tinea Capitis treatment

A

oral griseofulvin (first line), Terbinafine,

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14
Q

liver cysts. Dx? animal?

A

echinococcus.

dog or sheep

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15
Q

Generalized anxiety disorder. Time criteria? treatment–>firstline/secondline/thirdline

A

=/>6 months; 1. cognitive behavioral therapy. 2. SSRI/SNRI 3. Buspirone

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16
Q

MDMA. mechanism? SE?

A

synthetic amphetamine.

HTN, tachycardia, hyperthermia, hyponatremia, SEROTONIN SYNDROME

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17
Q

How to manage maternal HSV… if active while in labor? …if latent during labor?

A

active: c section
latent: acyclovir/valacyclovir at 36 wks

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18
Q

CMV retinitis is concerning at what CD4 count? sx? fundoscopic exam?

A

hemorrhagic and ischemic fluffy

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19
Q

Impetigo treatment?

A

mupirocin; oral dicloxacillin/cephalexin/clinda if severe

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20
Q

Infant with inspiratory stridor worse while laying down…dx? Versus Biphasic stridor infant …dx? No fevers in either

A
  1. laryngomalacia 2. vascular ring
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21
Q

children with increasing head sirc or ICP…what should you do first?

A

imaging–>CT/MRI

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22
Q

Normal pressure hydrocephalus treatment?

A

LPs

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23
Q

painless antepartum bleeding?

A

placenta previa

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24
Q

Placenta previa patient…what’s contraindicated?

A

digital vaginal exam

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25
Q

Ring enhancing lesion in HIV pt. how do you know if it’s toxo or CNS lymphoma?

A

Toxo: many rings, basal ganglia

CNS lymphoma: solitary, periventricular, EBV DNA in CSF

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26
Q

Pt with clinical DVT…what’s next?

Pt with clinical PE…what to do next?

A

DVT: compressive US
PE: start anticoagulation then do CTA

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27
Q

Autoimmune hemolytic anemia causes?

A

warm antibodies;

  1. Autoimmune
  2. drugs (penicillin)
  3. lymphoproliferative disorders (CLL)
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28
Q

T wave inversion ddx?

A
  1. MI
  2. Myocarditis,
  3. Pericarditis
  4. myocardial contusion
  5. digoxin toxicity
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29
Q

Erb’s palsy 2/2 shoulder dystocia… Treatment?

A

watch and wait. most will resolve

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30
Q

WPW sydrome. how to manage if 1. Hemodynamically stable

2. not stable?

A

If stable: procainamide for cardioversion

  1. if not stable: electroconversion
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31
Q

acid base change with loop diuretics?

A

alkalosis due to loss of H+ and volume contraction

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32
Q

tarsal stress fx. most likely location. How to treat?

A

second metatarsal

treat with rest and pain control; plaster cast if fails conservative treatment

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33
Q

fifth metatarsal fx is called?

A

Jones fx

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34
Q

Differential diagnosis for digital clubbing?

A

malignancy, CF, R to L cardiac shunting;

hypoxemia alone doesn’t cause any clubbing

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35
Q

Tetrology of Fallot predisposes kids to what kind of infections? why?

A 
Brain abscesses (especially if they also have chronic sinusitis); due R to L shunting of the heart
look for fever, HA, focal neurologica sx
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36
Q

Childhood CNS tumors

A

pilocytic astrocytoma, medulloblastoma, ependymoma, craniopharyngioma

Neuroblastoma is in the abdomen made of sympathetic ganglion cells

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37
Q

cocaine intoxication treatment? what do you need to avoid?

A

benzos to decrease SNS burden.
+/- nitrates, ASA, clopidogrel, PCI if has ST elevation
DO NOT give betablockers

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38
Q

ADPKD. How to diagnose?

A

abdominal US

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39
Q

ADPKD induced hypertension. first line treatment?

A

ACE inhibitor

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40
Q

ADPKD- extra renal manifestations?

A
  1. liver cysts
  2. berry aneurysm
  3. ventral hernia
  4. MVP/aortic regurg
  5. colon diverticula
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41
Q

pregnancy with placenta accreta. Treatment?

A

C section with planned ab hyst

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42
Q

sequence of events for DM nephropathy?

A

glomerular hyperfiltration–>renovascular HTN–>thickening of basement membrane–>mesangial proliferation–>nodular sclerosis/kimmelsteil wilson nodules

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43
Q

When do you screen pregnant person for DM?

A

Everyone at 24-28 weeks

If high risk (high BMI/previous gDM) then at first visit then again at 24-28 weeks

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44
Q

What are acceptable glucose values in pregnancy? (fasting, 1 hour post prandial, 2 hours post prandial)

A

fasting

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45
Q

initial gestational DM treatment? if that fails?

A

dietary. then insulin (or metformin/gliburide are ok too)

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46
Q

why does maternal DM predispose new born to RDS?

A

hyperglycemia–>fetal hyperinsulinemia–>insulin ihibits cortisol–>delayed lung maturity

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47
Q

SIADH related hyponatremia what is the first line of treatment?

A

fluid restriction.

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48
Q

demeclocycline. mechanism

A

inhibits ADH at level of kidney

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49
Q

how long can maternal estrogen stay in infant?

A

3 months

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50
Q

how do you diagnose multiple myeloma?

A

SPEP, UPEP, lambda/kappa ratio, blood smear

then maybe bone marrow biopsy if needed

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51
Q

bullous pemphagoid treatment?

A

high dose steroids

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52
Q

dermatitis herpetiformis. treatment

A

avoid gluten and dapsone

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53
Q

intradermal blisters with multinucleated giant cells on biopsy is?

A

VZV

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54
Q

what kind of gait is in Parkinson’s

A

narrow, shuffling, hypokinetic

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55
Q

wide based gait is seen in what

A

muscular dystrophies, peripheral nerve damage

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56
Q

waddling gait is seen in what

A

muscular dystrophies

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57
Q 
ATN
What cast?
what BUN:Cr ratio would you expect?
What urine osmo would you expect
What FENa would you expect?
A

muddy brown cast
BUN:Cr >20
Urine osmo will be >300 (about 300-350)
FENa >2%

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58
Q

what kind of casts are associated with chronic renal failure?

A

broad, waxy casts

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59
Q

RBC casts? where is the disease?

A

vasculitis induced casts; disease is in the glomerulus

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60
Q

WBC casts? ddx?

A

think pyelo. infection is in the kidneys

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61
Q

fatty casts?

A

nephrotic syndrome

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62
Q

Cystic fibrosis patients are at risk of developing what vitamin deficiencies?

A

DEAK. bc of pancreatic insufficiency.

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63
Q

name components of the extrinsic coagulation pathway

A

VII, X (with tissue factor/trauma activation)

increases PT

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64
Q

name components of the intrinsic coag pathway

A

XII, XI, IX, X (with VIII assisted activation of X)

Increases PTT

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65
Q

name components of the common coag pathway

A

X, II (Thrombin), I (fibrin), crosslink

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66
Q

borderline personality treatment?

A

psychotherapy

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67
Q

pt is in vfib. what do you need to do

A

unsynchronized defibrillation

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68
Q

pt is hemodynapically UNSTABLE in afib with RVR. what do you need to do?

A

synchronized direct electrical cardioversion (times to sync with QRS)

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69
Q

hemodynamically stable ventricular arrhythmias…tx?

A

amiodarone, lidocaine

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70
Q

rapid afib. tx for rate control? rhythm control?

A

rate= beta blockers & CCB

rhythm=amiodarone

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71
Q

5 criteria for in patient PID treatment?

A
  1. high fever
  2. doesn’t respond to oral abx
  3. can’t tolerate oral
  4. pregnant
  5. non compliant (teen, mentally challenged)
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72
Q

vomiting causes what in the potassium and chloride?

A

hypokalemia, hypochloremia. both due to DIRECT loss of potassium and HCl

73
Q

Somatic symptoms disorder. how long does it have to last for diagnosis?

A

6 months

74
Q

in infertility work up …how could you assess for anovulation?

A
  1. basal body temp
  2. progesterone level
  3. endometrial biopsy
75
Q

major depression diagnostic criteria

A

5/9 SIG E CAPS; for >2 weeks.

at least 1 has to be feeling down

76
Q

teen boy with recurrent nosebleed and intranasal mass?

A

angiofibroma. remove by specialist to prevent massive bleeding

77
Q

what ethnicity has highest risk of breast cancer?

A

white

78
Q

what age should mammos be started?

A

50

79
Q

at what CD4 is an individual at risk for pneumocystis? how to treat?

A

200; TMP-SMX

80
Q

esophageal rupture diagnosis method?

A

water soluble contrast swallow

81
Q

flailed chest treatment?

A

maintain oxygenation with mechanical positive pressure ventilation

82
Q

how to treat tension pneumo

A

needle thorocostomy

83
Q

atria tachycardia and heart block. what could cause this?, why?

A

Digoxin. because it increases ectopy and increases vagal tone

84
Q

SIADH first line of treatment? second line? third line? last line?

A

water restriction

  1. loop diuretics
  2. hypertonic saline if symptomatic hyponatremia
  3. demeclocycline
85
Q

Syndromic features of HUS

A

hemolytic anemia, thrombocytopenia, acute renal failure, bloody diarrhea.

-caused by E coli O157H7 and shigella, or strep (with meningitis)

86
Q

diabetic autonomic neuropathy induced gastroparesis….tx?

A

metoclopromide due to motility and antiemetic properties

87
Q

massive hemoptysis sequence of treatment?

A
  1. check for airway… if not patent place ET tube
  2. If hemodynamically stable and airway patent… put pt in dependent position to avoid accumulation of blood in opposing lung.
  3. bronchoscopy to stop bleed
  4. if bronchoscopy fails… do thorocotomy
88
Q

histologic features of breast fat necrosis?

A

globules of fat and foamy hystiocytes

89
Q

spontaneous abortion has to happen before what gestational age

A

20 weeks

90
Q

5 types of spontaneous abortion?

A

missed, threatened, inevitable, incomplete, spetic

91
Q

Secondary amenorrhea workup

A
  1. pregnancy test
  2. good history about patterns, stress/diet/exercise, medical problems, medications, family history
  3. prolactin, TSH, FSH
92
Q

Splenectomy. what vaccinations should be given and in what order?

A

PCV13 should be given 14 before or 14 days after splenectomy. Then PPSV23 should be given 2 weeks later…then again 5 years later and at 65 years.

Meningitis vaccination should also be given

93
Q

cyanide poisoning… treatments? x3

A

hydroxocobalamine, sodium thiosulfate, induce methemoglobinemia with oxidizing agents

94
Q

pheocromocytoma classic triad?

A

HA, tachy, diaphoresis

95
Q

electrical alternans… significant for what?

A

cardial tamponade

96
Q

eosin 5 maleimide is used to test what?

A

RBC lysis via hereditary spherocytosis

97
Q

Catatonia tx? x2

A

Benzos

ECT

98
Q

Three categories of asthma?

A

intermittent, mild persistent, moderate persistent, severe persistent

99
Q

What are the categories of evaluation asthma severity?

A

day time sx (times per week?), night time wakenings (times per month), SABA use per week, PFT (FEV1 >80%)

100
Q

DIG FAST.

Diagnostic criteria/length?

A

distractability, Insomnia, grandiosity
Flight of ideas, agitation, sexual indiscretion, talkativeness

mania for 1 week with 3 DIG FAST sx

101
Q

bipolar disorder treatment?

A

mood stabilizer (lithium/valproate)
+
Second generation antipsych (quetiapine)

102
Q

define brief psychotic disorder

A

Psychosis for

103
Q

define schizophreniform disorder

A

Psychosis for 1 month to 6 month

104
Q

define schizophrenia

A

psychosis for > 6 month

105
Q

positive sx and negative sx of schizophrenia?

A

Positive: hallucination, delusion, disorganized speech, catatonic behavior
Negative: flat affect, poverty of speech, social withdrawal

106
Q

features of MEN 1

A

pancreatic (gastrinoma, insulinoma, VIPoma)
parathyroid hyperplasia
pituitary adenoma

107
Q

features of MEN 2A

A

medullary carcinoma
parathyroid hyperplasia
pheochromocytoma

108
Q

MED 2B features

A

medullary carcinoma
pheochromocytoma
mucosal neuromas
marfanoid body habitus

109
Q

difference of intrauterine fetal demise versus spontaneous abortion?

A

spontaneous abortion 20 wks

110
Q

how to dx cause of intrauterine fetal demise?

A

autospsy, placental microanalysis

111
Q

When do you do blood typing/alloimmunzation characterization in pregnancy?

A

at first visit

112
Q

when do you give anti D immune globulin for Rh neg women?

A

at 28 weeks and again within 72 hours of delivery/trauma

113
Q

thalassemia minor..tx?

A

nothing!!!

114
Q

“midsystolics click”

A

mvp

115
Q

pt with low back pain. you strongly suspect malignancy…what’s the first steps in workup?

A

Plain film xray + ESR

if ESR elevated proceed to MRI

116
Q

breastfeeding is recommended for what time period?

When do you start introducing solid foods?

A

breastmilk alone fo 6 months, then in conjunction with solid foods until 1 year

117
Q

two pathways of homocysteine?

A

either to methionine(methionine synthase +B12) or to cysteine (cystathionine beta synthase +B6)

118
Q

homocysteine –>methionine. enzyme? cofactor? also creates what?

A

methionine synthase, B12, tetrahydrofolate

119
Q

homocysteine–>cystathionine/cysteine. What enzyme? what cofactor?

A

cystathionine beta synthase, B6

120
Q

What is B6 called?

A

pyridoxine

121
Q

What’s B12 called

A

cobalamine

122
Q

what’s B9 called?

A

folate

123
Q

What’s B1?

A

thiamine

124
Q

paroxysmal nocturnal hemoglobinuria. mechanism of disease?

A

lack of CD55 and CD59 –>can’t inactivate complement attachment and RBC destruction

125
Q

three cardinal features of parosyxmal nocturnal hemoglobinuria?

A

anemia, hemolysis/hemoglobinuria, hypercoagulability

126
Q

epiphyseal tumor with “soap bubble appearance” in a young adult. treatment?

A

giant cell tumor

surgery is firstline tx

127
Q

fine motor/action tremor? tx?

A

essential tremor. propranolol (primodone, topiramate)

128
Q

diagnosis of achalasia?

A

can do barium swallow, but manometry is gold standard

129
Q

esophageal spasm diagnosis? treatment?

A

Esophagram shows “corkscrew esophagus”.

tx: calcium channel blocker

130
Q

urinary incontinence due to overactivity? first line tx? second line?

A

bladder training/kegels

antimuscuarinics

131
Q

klinefelter karyotype?

A

XXY

132
Q

cirrhotic with fever and airfluid level in bowels… what should you think of?

A

spontaneous bacterial peritonitis

133
Q

diagnosis of spontaneous bacterial peritonitis?

A 
positive culture (usually e coli/klebsiella)
neutrophil of >250/mm3
134
Q

treatment of spontaneous bacterial peritonitis?

A

third gen cephalosporins.

Ceftriaxone, Ceftazidime

135
Q

list 5 drugs that can cause folate deficiency

A

methotrexate, trimethoprim

Phenobarbital, phenytoin, primidone

136
Q

firstline treatment of conversion disorder

A

education, support, encouragement

137
Q

ARDS diagnostic criteria?

A
  1. acute respiratory distress
  2. no cardiac causes
  3. PaO2/FiO2
138
Q

treatment of ARDS

A

low tidal volume with titration of PEEP and FiO2 (goal

139
Q

In pregnancy what happens/why to thyroid binding globulin?
total T4?
free T4?
TSH?

A
  • Thyroid binding globulin increases due to estrogen
  • total T4 increases due to hCG (same alpha unit as TSH)
  • free T4 is about the same
  • TSH decreases
140
Q

Thyroxine management in pregnancy?

A

If pt is stable prior to pregnancy… thyroxine should be increased 30% when pregnant.

141
Q

Lead exposure concern should be brought up in houses how old?

A

before 1960

142
Q

non treponemal tests

A

RPR, VDRL

143
Q

treponemal tests

A

FTA-ABS; darkfield microscopy

144
Q

kleptomania treatment

A

cognitive behavior therapy, SSRI

145
Q

renin-angiotensin-aldosterone acts on afferent or efferent arteriole?

A

constricts efferent

146
Q

ACE inhibitor does what to renal arterioles?

A

dilates efferent

147
Q

Asprin does what to renal arterioles?

A

dilates efferent arterioles (inhibits prostaglandins)

148
Q

most common cause of sepsis in term babies? premature babies?

A

term: GBS
preterm: e coli

149
Q

Risk of AAA expansion and rupture is most increased by what?

A

current smoking

150
Q

when do you treat an AAA?

A

when >5.5 or expanding beyond 1cm per year

OR symptomatic

151
Q

first line treatment to pathologic GERD in infants with failure to thrive?

A

thickened feed + PPI

152
Q

What is SAAG? What is it used to determine? what value indicates what?

A

Serum ascites albumin gradient. Used to determine if ascites is from portal hypertension or other causes… if SAAG >1.1 then it is due to increase in hydrostatic tensions

153
Q

What kind of heart defect is associated with Edwards syndrome?

A

VSD

154
Q

What age should Tdap be given/Td?

A

Tdap should be given between 11-18 (or whenever) then Td every 10 years

155
Q

How old is the minimum age for influenza vaccine?

A

6 months

156
Q

MCA stroke sx?

A

mostly upper extremity upper motor neuron defects
quadrantanopia, hemianopia
agnosia, hemineglect, aphasia

157
Q

what kind of pH would you expect in enpyema fluid? glucose?

A

pH

158
Q

light criteria. What is it used for? What are the criteria?

A

Light criteria is used to determine if fluid is exudative.
Protein: fluid/serum >0.5
LDH: fluid/serum >0.6

159
Q

features of traumatic pulmonary contusion?

A

worsening SOB in hours following blunt trauma. fluids makes it worse.

160
Q

features of fat embolus?

A

SOB, AMS, petechia

161
Q

what nerve provides sensation to anterior and medial thigh/leg?

A

saphenous branch of the femoral nerve

162
Q

acute dystonia. what is it and treatment?

A

sudden sustained muscle contractions associated with antipsychotic meds.
tx: Benztropine, Diphenhydramine

163
Q

parkinsonism due to antipsychotic meds. treatment?

A

benztropine, amantadine

164
Q

akathesia. what are the symptoms and what are the treatments?

A

propranolol, benzodiazepines

165
Q

what two types of previous surgeries are contraindication of “trial of labor”?

A
  1. Classical C section (vertical incision)

2. Myomectomy with uterine ENTRY

166
Q

firstline treatment for mild hypovolemic hypernatremia?

severe hypovolemic hypernatremia?

A

for mild D5W 1/2 NS

for severe NS

167
Q

Massive PE. what are the symptoms? What are some ECG and PEx findings?

A

CP, SOB, hypoperfusive sx
ECG: RBBB (R heart strain)
PEx: JVP increase, hypoperfusion, rapid death

168
Q

main substrates for gluconeogenesis (4)

A

Proteins: alanine –>pyruvate; glutamine–>a-ketoglutarate
lipids: glycerol 3 phosphate
lactate

169
Q

how should lithium therapy be managed for pts with bipolar disorder when becoming pregnant?

A

should be WEANED.

170
Q

How do you treat ITP without bleeding? what if the pt is bleeding?

A

observation if no bleeding.

IVIG if bleeding + glucocorticoids

171
Q

ITP patient with severe thrombocytopenia;do you give platelet transfusion? why?

A

no because it will result in more destruction

172
Q

features of interstitial nephritis?

A

renal failure, fever, rash, arthralgia, eosinophiluria, WBC cast

173
Q

What are the 4 etiologies of acute interstitial nephritis

A

antibiotics, diuretics, NSAIDs, infections

174
Q

aortic dissection. Firstline treatment? What is the goal of this therapy?

A

IV Labetalol.

Goal is to reduce HR, contractility, and SBP

175
Q

Glucocorticoids can cause leukocytosis… increases what kind of cells and decrease what kind of cells?

A

increases neutrophils by mobilization of marginalized cells, stimulate maturation, and decrease apoptosis
-it also decreases lymphocytes and eosinophils

176
Q

pt with footdrop 2/2 radiculopathy. What nerve is pinched?

A

L5

177
Q

What is First degree heart block

A

simple prolongation of PR interval of >0.2 seconds

178
Q

what are the 2 second degree heart blocks?

A

Wenckebach I: long long long drop

Wenckebach II: random dropped beat

179
Q

What is third degree heart block?

A

atria and ventricle are beating independent of eachother.
Atria usually about 60-100 bpm
Ventricle usually about 40 bpm
Could lead to ventricular arrhythmias and asystole

Step 2 CK (5 decks)

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