UWorld Q Bank: Week of 04/23/18 Flashcards
Review the diagnostic criteria for generalized anxiety disorder.
•Excessive, uncontrollable worry for greater than 6 months •At least 3 of the following: - Difficulty concentrating - Irritability - Muscle tension - Restlessness - Edge (feeling on...) - Fatigue - Sleep disturbance
(Notice the order of the list: DIM REFS.)
Review the management of preterm labor.
•34 - 36 weeks:
- Steroids, penicillin (if GBS+ or unknown)
- Delivery
•32 - 34 weeks:
- Steroids, penicillin (if GBS+ or unknown)
- Tocolytics to stall delivery if possible (indomethacin or nifedipine)
• < 32 weeks:
- Same as above but add MgSO4 to lower risk of neurologic complications in the fetus
Lesson: the risks of tocolytics outweigh the benefits after 34 weeks.
Someone presents with hemorrhagic bullae after a cut on a boat at sea. What other comorbidity increases the risk of infection with this organism?
Liver disease
The stem describes soft tissue infection from Vibrio vulnificus, which is common in marine cuts and in those with liver disease. It is usually rapidly progressive.
True or false: high prolactin levels can suppress TSH.
False
TSH can only be suppressed by mass effect, so TSH should be normal unless the prolactinoma is huge and suppressing all pituitary hormones.
What range of prolactin is typically seen in those with prolactinomas?
> 200
The normal is less than 15, but tumors that are symptomatic generally cause extreme elevations in prolactin.
________________ usually occurs within 48 hours after an ischemic stroke.
Hemorrhagic transformation
True or false: tetanus occurs from the blockage of presynaptic acetylcholine release.
False
Botulism results in the inhibited release of acetylcholine. Tetanus results from the blocked release of GABA glycine in the Renshaw inhibitory cells of the spine.
High lost-to-follow-up rate leads to what kind of bias?
Selection
____________ causes urine osmolarity to be > 100 mOsm.
SIADH
SIADH causes high urine osmolarity and _________ urine sodium.
high ( > 40 mEq)
This is important. In dehydration, the urine osmolarity will be high but the urine sodium should be low (because of high aldoseterone).
What type of hyperthyroidism presents with a tender thyroid and elevated ESR?
DeQuervain’s subacute thyroiditis
Prolonged recumbence increases the risk of which type of syncope?
Orthostatic
How ought you to handle an amputed digit for possible reattachment?
- Drape in a saline-moistened sterile dressing (if available)
- Place on ice but not directly (that is, ensure that it does not freeze)
True or false: acute cholecystitis can cause elevated bilirubin.
True
If a patient with RUQ pain and fever has mildly elevated direct bilirubin but a normal alkaline phosphatase, then this is likely acute cholecystitis.
Those who have an injury suspicious for tetanus should get TDaP (if they haven’t in the last ten years) and immune globlulin if ____________.
they are symptomatic or have a dirty/severe wound
Which kind of pneumonia presents with a macular rash?
Mycoplasma
If the diagnosis of carpal tunnel syndrome is uncertain, _______________ can be used to definitively diagnose.
nerve conduction studies (not EMG!)
The attributable risk percentage is given by this formula: ______________.
(RR - 1) / RR
__________ is a norepinephrine-dopamine reuptake inhibitor.
Buproprion
When a patient has a partial response to an antidepressant, the best thing to do is ________________.
add another agent (when that one has been maximally dosed)
1) Antidepressant with a different mechanism (buproprion, mirtazapine, trazodone, etc.)
2) Atypical antipsychotic
3) Lithium
4) T3
Patients at risk for ACS should be given aspirin while you are doing ECG and troponins unless _____________.
they have signs of aortic dissection (uneven pulses/BP, widened mediastinum on CXR, etc.)
Don’t forget that the most common cause of cervicitis is _______________.
Chlamydia (don’t be tricked if they tell you that the cervix has yellow discharge –they might be disguising the fact that this is mucopurulent discharge)
Elevations in maternal AFP can be caused by multiple gestations, neural tube defects, and ____________.
abdominal wall defects
Just think of the liver leaking AFP into the amniotic fluid.
The defect in Wiskott-Aldrich syndrome is ________________.
a cytoskeletal protein on the X chromosome
Just think of skeletons with recurrent abscesses floating in WATER.
A young African American man presents with polyuria. US shows hyposthenuria. His mom died of a stroke at a young age. What is the likely pathology?
Sickle cell trait
Those with SCT have microocclusions in the vasa rectae of the kidneys. This leads to impaired water resorption (because the kidney vessels are clogged) and thus persistent dilution of the urine.
A patient with an anaerobic abscess in the cervical lymph nodes likely has what other comorbidity?
Dental caries or periodontal disease
Acromegaly causes what cardiopulmonary complications?
Concentric cardiac hypertrophy with pulmonary edema
The layers of the heart build up in response to elevated IGF-1.
Explain the assessment and management of tick bites.
- For all ticks, remove with forceps.
- If the tick has been present for more than 48 hours, you are in a Lyme-endemic area, and the tick is an Ixodes tick, then doxycycline prophylaxis is indicated.
- If the tick has been present for less than 48 hours, you are not in a Lyme-endemic area, and it is not an Ixodes tick, then doxycycline prophylaxis is not indicated.
A man comes to you with the following findings:
•AKI
•Livedo reticularis
•Eosinophilia
What procedure did he recently have?
Stenting or carotid endarterectomy
These are findings of cholesterol embolus.
Bullous pemphigoid is common in _____________.
elderly people with neurologic problems (e.g., Parkinson’s, Alzheimer’s)
What is a pertinent negative finding in someone with pericardial effusion?
Nonpalpable PMI
What non-malignant skin cancer often ulcerates?
SCC
“It ulSCCerates.”
Which antibody is associated with primary biliary cirrhosis?
Anti-mitochondrial
Anti-smooth-muscle antibodies are associated autoimmune hepatitis.
Amphetamine use during pregnancy is associated with what complication?
Intrauterine growth restriction
Differentiate malposition and malpresentation.
- Malposition: how the head is oriented (“What is the baby’s pose?”)
- Malpresentation: breech or not
Methemoglobinemia can result from exposure to nitrites, dapsone, or _______________.
topical anesthetics (lidocaine on a toothache)
Those with methemoglobinemia typically have SpO2 in the ___________.
80s; this is due to the absorption spectrum of methemoglobin and not true oxygen saturation, though they will be hypoxic due to the decreased availability of functional hemoglobin
True or false: the risk of testicular cancer in babies with undescended testes becomes the same as those with descended testes if orchiopexy is done before age 1.
False
It is always a bit higher.
____________ is diagnosed by the appearance of Maltese crosses within RBCs on a smear.
Babesiosis
Babesiosis presents with these symptoms: _____________.
fever, thrombocytopenia, hemolytic anemia, transaminitis, and AKI
Importantly, no rash!
Which is the firstline treatment for BPH-related urinary retention?
Alpha-1 blockers
5-alpha reductase inhibitors should also be added, but generally they take longer and have more side effects so are not firstline.
Those with WPW are at increased risk of which arrhythmias?
- Atrial fibrillation
- AVRT
- Ventricular fibrillation (usually secondary to rapid ventricular response from one of the above two)
Go through the management of rabies in bites from these animals:
- High-risk wild animals (racoons, coyotes, bats):
- Low-risk wild animals (squirrel, rabbit):
- Domesticated animal:
- High-risk wild animals (racoons, coyotes, bats): start PEP
- Low-risk wild animals (squirrel, rabbit): observation
- Domesticated animal: quarantine animal and start PEP if animal shows signs; if animal unavailable for quarantine then start PEP
Weirdly, wheezing can be a sign of _______________.
pulmonary embolus
I’d never heard this in third year, but UWorld says there can be cytokines released in a PE that lead to bronchoconstriction.
The A-a gradient will be ___________ in those with PEs.
high (due to shunting)
By definition, depression is pathologic if it persists longer than ___________ after delivery.
2 weeks (hence the 4-week checkup)
The milder version of an infection around the eye is _____-septal cellulitis.
pre
Remember that the distinguishing test is pain with EOM or diplopia.
True or false: COPD has to be extreme to cause digital clubbing.
False
COPD does not cause digital clubbing because it is an obstructive disorder, not a hypoxemic disorder.
Officially, you should not give tetracyclines to a kid younger than _____.
7 years old
With disorders that would indicate it –such as Lyme disease –you give amoxicillin instead (and save ceftriaxone for tertiary presentations).
Elevated alkaline phosphatase and _____________ are suggestive of Paget disease of the bone.
urinary hydroxyproline (remember that hydroxyproline is a modified amino acid important in bone collagen)
A subjective sandy/gritty feeling in the eyes is typical of _____________ conjunctivitis.
viral
Which monoclonal antibody used in cancer treatment can cause HFrEF?
Trastuzumab
Remember the unraveling heart on the tapestry.
When do you give corticosteroids in the treatment of PCP?
When PaO2 is less than 70 on RA
Giving additional radiation after an initial treatment fails is called _____________.
salvage
List two other diseases seen in conjunction with pernicious anemia.
- Hashimoto’s
* Vitiligo
Oxytocin can cause what electrolyte abnormality?
Hyponatremia
It is similar to ADH and can cause an SIADH-like syndrome if given in high doses.
What is tachysystole?
Excessively frequent uterine contractions (> 5 in ten minutes)
Remember that poison ivy is a __________ dermatitis.
contact
The proper management of a potential scaphoid fracture (FOOSH with pain in the anatomical snuffbox) is ______________.
immobilization with a splint and repeat radiography in 2 weeks
Even well-controlled hypertension in pregnancy can lead to __________________.
IUGR
Meningitis with a petechial rash arises from what etiology?
N. meningitidis
This is the only kind of meningitis that causes a rash.
Whipple disease presents with diarrhea, PAS-positive inclusions on small-bowel biopsy, polyarthropathy, and ______________.
valvular problems (regurgitation)
A large mediastinal mass with elevations in ______________ is suggestive of a non-seminomatous germ-cell tumor.
bHCG and AFP
Cholesterol emboli can cause livedo reticularis, AKI, and _____________.
pancreatitis
Hgb less than ______ is an indication for EPO treatment in those with CKD.
10
EPO treatment can cause what complication (particularly in the first 8 weeks)?
Hypertensive emergency
List four treatments that can be used to treat acute angle-closure glaucoma.
- Mannitol
- Acetazolamide
- Timolol
- Pilocarpine
A woman comes in with symptoms of hyperthyroidism. Testing shows an elevated TSH and elevated T4. Your next step should be to _____________.
MRI her brain
The only explanation for this is a TSH-secreting tumor, which is most commonly seen in the pituitary. This is a rare cause of hyperthyroidism.
As in dibetic ketoacidosis, those with non-ketotic hyperosmolar syndrome have falsely elevated levels of ______________.
potassium
The insulin deficiency and serum hyperosmolarity seen in each of these disorders drives potassium out of cells and into the urine.
Part of _____________ is making connections between risky behavior and negative consequences, like “Do you think that drinking is part of why you were too tired on Saturday to make your son’s baseball game?”
motivational interviewing
A man with recent ventricular tachycardia presents with SOB and middle-lobe opacities. What is the likely cause?
Amiodarone toxicity
Amiodarone can present with migratory reticular opacities that are focal.
What vital signs and physical exam findings are suggestive of marijuana intoxication?
PE:
- Conjunvtival injection
- Dry mouth
VS:
- Tachycardia
- Tachypnea
Review the management of subconjunctival hemorrhage.
Subconjunctival hemorrhage may be benign or a sign of something more serious. As such, you need to rule out the potentially serious disorders. Once those disorders have been ruled out, there is nothing you need to do but observe.
Here are the potential associations:
- Hypertensive emergency
- Coagulopathy
- Coughing paroxysms
Progesterone is made by the _____________.
corpus luteum
Left-ventricular hypertrophy is indicative of what?
Increased afterload, which may be from three things:
- Long-standing HTN
- Coarctation of the aorta
- Valvular stenosis
Why do those with severe forms of obstructive lung disease have pulsus paradoxus?
The drop in intrathoracic pressure is greatly exaggerated in those with severe obstructive disease (unclear why). The extreme drop in pressure causes a larger influx of blood into the right ventricle, pressing against the left and leading to drop in LV preload.
A woman presents with erythema nodosum and arthritis. What should you do to work up her suspected sarcoidosis?
Chest x-ray
Biopsy should only be done if the erythema nodosum lesions are atypical (and might be malignant or infectious). If they are typical lesions, biopsy would not help because it would show nonspecific inflammation.
Galactorrhea is associated with which kind of lung cancer?
Large cell carcinoma
True or false: IgA nephropathy presents with low levels of C3 and C4.
False
Primary biliar cirrhosis is now called ________________.
primary biliary cholangitis
PBC commonly presents with extreme elevation in what serum test?
Lipids, specifically HDL and total cholesterol
Those with PBC can present with xanthelesmas secondary to hyperlipidemia.
To what nutritional deficiencies are those with PBC predisposed?
Fat-soluble vitamins
PBC limits the liver’s ability to secrete bile, thus preventing emulsion of fat.
A man presents with a widened mediastinum on CXR, but his overall exam and vitals are stable. Also, he has only mild pain of insidious onset. What is the likely diagnosis?
Thoracic aortic aneurysm
This can look like a dissected aorta, but the presentation will be slower and more mild compared to aortic dissection.
Atherosclerosis is a risk factor.
If a person presents with B symptoms and has a uniformly enlarged thyroid, what malignancy might they have?
Thyroid lymphoma
This is an uncommon kind of lymphoma, but its incidence is increased in those with Hashimoto’s thyroiditis. Thyroid lymphoma frequently invades into the retrosternal structures, so think of this if a person presents with B symptoms, an evenly enlarged thyroid, and dysphagia or hoarseness.
Explain the difference in small-fiber axonopathy and large-fiber axonopathy (the kind of neuropathy seen in diabetes).
- Small-fiber: positive symptoms (pain and paresthesia)
- Large-fiber: negative symptoms (numbness)
(Think: PSP and LNL.)
Lobar pneumonia, arthritis, and erythema nodosum are suggestive of what infection?
Coccidiodes (“Valley Fever”)
Because you’re an idiot and almost missed this question for a second time, review the management of preterm labor in these timelines:
•34-37 weeks
• 32-33 weeks:
• <32 weeks:
- 34-37 weeks: betamethasone and penicillin
- 32-33 weeks: betamethasone, penicillin, and tocolytics (indomethacin and nifedipine)
- < 32 weeks: betamethasone, penicillin, tocolytics, and MgSO4
Women with a history of preterm labor and short cervix should be given _____________ to recurrent preterm labor.
progesterone
Some children can develop ___________ after receiving the MMRV vaccine.
fever and a maculopapular rash
This is actually a mild form of measles, but it is entirely benign because the virus is attenuated. Still, children with this reaciton should be kept away from the immunocompromised because it can be contagious.
Those who chronically abuse laxatives can have what colonoscopy finding?
Hyperpigmented mucosa
Remember the “senna henna tatoo” mnemonic from Step 1 studying!
