UWorld Q Bank: Week of 04/30/18 Flashcards
What age is typical of stranger anxiety?
6-24 months
Most small-bowel obstructions can be managed with conservative treatment: NG tube suction, correction of metabolic derangements, and bowel rest. What are signs that indicate emergent surgical intervention?
Hemodynamic instability, fever, AMS, significant metabolic acidosis
Dark urine indicates high levels of ___________ bilirubin.
conjugated
Those with Crohn’s are at increased risk of kidney stones due to increased _______________.
absorption of oxalate
A young girl presents with axillary hair but no breast buds. How can you distinguish CAH from premature adrenarche?
CAH causes more significant androgen rise and will result in advanced bone age.
True or false: membranoproliferative glomerulonephritis is the only glomerulopathy that is increased in those with HBV.
False
Membranous nephropathy – another nephrotic syndrome – is also seen in those with HBV and is actually significantly more common.
___________ can be seen in children with recurrent AOM. Look for it if they have ear drainage and hearing loss.
Cholesteatoma
What symptom distinguishes heat stroke from heat exhaustion?
AMS
Think of the name: stroke!
____________ presents with hexagonal crystals on urine microscopy.
Cystinuria
Which non-opioid medication is sometimes used in the treatment of opioid withdrawal?
Alpha-2 agonists (clonidine)
Decompensated CHF leads to what effect in the renal vasculature?
Increased RAAS pathway leads to constriction of both the afferent and efferent arterioles, though moreso the efferent.
According to UWorld – this is different from what the HAC lecturers told us – the best treatment for chemotherapy-induced nausea is _____________.
Zofran
Which lab value can help distinguish central from peripheral adrenal failure?
Potassium
K is low in primary adrenal failure (like Addison’s or Waterhouse-Friedrichsen) but normal in secondary adrenal insufficiency (like those given high-dose steroids who undergo major stressors like surgery). This is because the RAAS system can operate independently of ACTH.
The official time within which oseltamivir must be given is ________________.
within 48 hours of symptom onset
Cyanide toxicity –commonly seen in those treated with nitroprusside who also have AKI –can present with lactic acidosis, AMS, and _______________.
seizures
Aquagenic pruritis –getting itchy while showering –is a symptom of _______________.
polycythemia vera
Don’t forget that diffuse esophageal spasm responds to _____________.
nitrates, another reason why it looks like angina .
There are two groups of people with COPD who should be started on long-term oxygen therapy. Give the criteria.
- SpO2 < 88% or PaO2 < 55 mm Hg on RA
* SpO2 < 85% or PaO2 < 59 mm Hg on RA if they have cor pulmonale or Hct > 55%
Review the screening guidelines for those with APC mutations.
- Annual sigmoidoscopies starting at age 10-12
* Annual colonoscopies whenever adenomas are detected
Carotid endarterectomy should be done in those who meet what criteria?
- TIA or stroke in those with > 70% stenosis
* Asymptomatic with > 80% stenosis
This is an important one
Review the criteria for diagnosing gestational diabetes.
•Step 1: 50-gram glucose challenge 24-28 weeks
- Positive if > 140 at 1 hour
•Step 2: 100-gram glucose challenge if step 1 is positive; step two is positive if any two of these four criteria are met.
- Fasting > 95
- 1-hour > 180
- 2-hour > 155
- 3-hour > 140
Human placental lactogen is a type of _____________.
somnatomammotropin
Those being treated for TB can develop anemia secondary to _____________.
B6 deficiency (needed for heme synthesis)
Those with defective CD40 develop which condition?
Hyper-IgM syndrome
The CD40 ligand induces class switching in B lymphocytes.
Remember, it is X-linked.
Lymphopenia presents in which of the immunodeficiency disorders?
SCID and Bruton’s
All of the others – hyper-IgM, CVID, IgG subclass deficiency, and IgA deficiency – present with either normal or elevated lymphocytes.
A patient presenting with edema, proteinuria, hepatomegaly, and an S4 should make you think of ____________.
amyloidosis
In addition to the classic symptoms of fatigue, weakness, hyponatremia, and hyperkalemia, adrenal insufficiency commonly causes ______________.
diarrhea
When you see symptoms/signs of adrenal insufficiency, the best workup is _____________.
cortisol level, ACTH level, and cosyntropin stimulation test
Ventricular aneurysms can cause what murmurs?
Mitral regurgitation
The dilation of the ventricle can pull open the mitral annulus.
A flow-volume loop showing flattening of the expiratory peak (the top part) and the inspiratory peak (the bottom part) indicates ______________.
upper-airway obstruction (such as laryngeal edema)
Intense anogenital pruritus with a pale-appearing vulva and anus indicates _____________.
lichen sclerosus
The big difference between this and vulvovaginal atrophy is perianal involvement.
How do torus palatinus develop?
They are congenital.
Streptococcus viridans is a member of what group of bacteria that are implicated in endocarditis of damaged valves?
Streptococcus sanguinis
Describe bullous myringitis.
AOM can uncommonly cause bullae on the tympanic membrane, called bullous myringitis.
By definition, serous otitis media presents with absence of _____________.
inflammatory signs (e.g., fever, immobility of the TM)
A patient with mania presents one month after hospitalization with transaminitis and a tremor. What is the likely cause?
DILI from valproate
When should the flu vaccine be given in pregnancy?
Whenever it is available. It is safe in every trimester of pregnancy and shoiuld always be given.
A man comes in with rhinorrhea, cough, and focal crackles on lung exam. His vital signs are all within normal limits. What is the proper next step?
CXR
What is the workup of primary amenorrhea?
•US looking for uterus
- If present, then test FSH
- If absent, then karyotype
White plaques on the buccal mucosa in a smoker are likely ______________.
leukoplakia, a precancerous lesion
All people should start colonoscopy screening at age 50 or __________.
ten years before the age at which any first-degree relatives developed colon cancer
HIT rarely causes platelets to drop below ___________.
20,000
HIT causes what pattern of clotting?
Arterial and venous
What timeline is typical of HIT?
HIT usually starts 5-10 days after administration of heparin, but it can start as early as 1 day.
Describe the presentation and treatment of amniotic fluid embolism.
Presentation:
- Cardiogenic shock (hypotension, cold extremities, tachycardia)
- Hypoxemic respiratory failure
- Petechiae
- DIC
Treatment:
- Intubation and mechanical ventilation to maximize respiratory drive
- Hemodynamic support (fluids and possible RBC transfusion)
True or false: long-acting opioids have a lower risk of morbidity.
False
They have a higher risk.
Heinz bodies are made of _______________.
hemoglobin precipitated due to oxidative stress (when glutathione is not there to take the oxidative damage generated by metabolism)
True or false: febrile seizure within one week of giving a vaccine is a contraindication to future doses of that vaccine.
False
Only encephalopathy and anaphylaxis are contraindications to future vaccine.
“Careful chewing” is Step 2 code for ____________.
dysphagia
Describe the screening protocols for bladder cancer.
No screening is indicated, even in those with multiple risk factors.
How often is right-ventricular MI seen in those with inferior MI?
About 50%
What kind of fluid should be given to those with DKA?
NS
When those with DKA have potassium less than 3.3, you need to hold _____________.
insulin
According to UWorld, the proper initial management of Kawasaki’s is _____________.
aspirin and IVIG followed by echocardiography
Describe the tools to diagnose aneuploidies.
- The maternal quad screen is done at 9-13 weeks and is a screening.
- The nuchal translucency is done at 15 weeks and is also a screening.
- Chorionic villus sampling is done at 9-13 weeks and can diagnose aneuploidies early.
- Amniocentesis is also able to diagnose aneuploidies and can be done 15-22 weeks.
(Think: chorionic vil1u3 sampling and amn1ocente5is.)
Varicella immune globulin should only be given ______________.
to those who are immunocompromised
Those with peripheral artery disease are actually more likely to develop _____________ than critical limb ischemia.
myocardial infarction
What is the one instance in which parental refusal of medical care can be overruled?
If a parent refuses life-saving therapy for a child, then you must overrule. For instance, if a child needs to be intubated and a parent refuses you must act in the interest of the child.
How does pH affect serum calcium?
Alkalosis causes more calcium to bind to albumin. Acidosis causes albumin to release calcium.
This is why hyperventilation causes paresthesias: the drop in pCO2 causes a shift in calcium from the serum to the albumin, thus causing hypocalcemia and hence paresthesia.
What are some features of hirsutism that make it more likely to be due to a testosterone-secreting tumor or CAH?
- Rapid-onset (less than 6 months)
- Extreme hirsutism (back hair, coarse facial hair)
- Presence of voice deepening or clitoromegaly
How is the Rinne test done?
You place a tuning fork on the mastoid. When the person reports no longer hearing it, you move it to the external auditory meatus. They should be able to hear it. If they can’t, this indicates a conductive hearing loss (as opposed to sensorineural).
Otosclerosis commonly presents in ____________.
young people (20s and 30s)
Visual problems and inflammatory cells in the anterior chamber after cataract surgery indicate _______________.
post-operative endophthalmitis
Describe the diagnosis of HCV.
- First, test for HCV antibody.
* Second, test for HCV RNA. (This is needed to confirm ongoing infection, which would indicate treatment.)
How does tension pneumothorax lead to decreased CO?
By occluding the IVC/SVC
This is important: a left-sided tension pneumothorax does not occlude the aorta or LV.
Describe the management of PPROM.
- PPROM = preterm premature rupture of membranes (leaking fluid with no labor before 37 weeks)
- No matter the date, any sign of fetal compromise (by FHR or NST) indicates urgent delivery
- 34 - 37 weeks without compromise: antibiotics, steroids, non-urgent delivery
- < 34 weeks without compromise: antibiotics, steroids, observation
The triad of Meniere disease: ________________.
tinnitus, vertigo, hearing loss
A person with neutropenia, hemoptysis, and nodular opacities in a single lobe of the lung likely has ______________.
invasive aspergillosis (which can present with ground-glass opacities around the nodules)
New-onset hirsutism and acne in a pregnant woman with bilateral ovarian masses is likely _____________.
luteomas, a benign tumor presentation of testosterone-secreting ovarian masses that resolves with delivery
Fetal virilization is common.
More commin in AA women.
Pain with extension of the knee while pressing down on the patella is indicative of ________________.
patellofemoral pain syndrome
Patellofemoral pain syndrome presents with anterior knee pain that worsens with _______________.
climbing stairs
Which part of the eye is usually affected in anterior uveitis?
The iris
Look for signs of inflammation of the iris, particularly synechiae (adhesions of the iris that overly the pupil), Koeppe nodules, and peri-iris inflammation.
Prolonged contact use can lead to _______________.
keratitis, a bacterial infection of the cornea usually caused by Pseudomonas or Serratia
On exam, look for opacification and ulceration of the cornea with inflammation of the conjunctiva.
The diaphragm can rise as high as the ______________ on expiration, so exploratory laparotomy should be considered in any penetrating trauma below this level (especially if the person is hemodynamically unstable).
nipples (4th intercostal space)
When you suspect SVC syndrome –based on edema of the upper extremities and head that is worst upon awakening –the best diagnostic is ____________.
CXR
What is a biophysical profile? When is it done?
- The biophysical profile is a set of five tests: Heart rate variability, Volume of amniotic fluid, fetal Movement, fetal Tone, and fetal Breaths. (Remember the mnemonic “Help Visualize My Tiny Baby.”)
- The categories are scored 0-2 for a total of 10 possible. ≥ 8 is normal, 6-7 is equivocal, and < 6 indicates delivery.
- It is usually done at 41 weeks to assess post-dates babies. It can be done earlier to assess the fetus if there is any question.
Sudden-onset pain with vaginal bleeding and a firm uterus likely indicates _____________.
placental abruption
This could describe placental rupture, but (1) the woman would need to be in labor and (2) she would be extremely hemodynamically unstable.
Those with what comorbidity are at increased risk of hypocalcemia in a transfusion?
Liver injury
The liver can rapidly metabolize citrate (the moledule in RBCs that is responsible for hypocalcemia), but if the person has liver dysfunction this clearance is impaired.
Septic emboli from tricuspide endocarditis can lead to what pulmonary manifestation?
Scattered cavitary lesions in the lung parenchyma
Review the differential for anterior, middle, and posterior mediastinal masses.
- Anterior: thymom, teratoma, terrible lymphoma, and thyroid goier
- Middle: bronchogenic cyst, lymphoma, lymphadenopathy, aortic aneurysm, tracheal tumor
- Posterior: esophageal cancer, neuroblastoma
Screening for lead poisoning is usually done with capillary finger pokes. Describe how you interpret a positive result.
Capillary measurements are prone to false positives. If you see a positive capillary result, you need to verify it with a venous draw.
Although molluscum contagiosum is common in people with no other problems, ________ testing should be considered if an adult has many MC lesions that are large.
HIV
____________ can be used to treat molluscum contagiosum.
Podophyllotoxin
MPGN is caused by what antibodies?
IgG against C3 convertase, which activates the complement pathway. This allows for the GBM to stain for C3 but not IG.
__________ can present with a single group of vesicles on the hand after a viral prodrome.
HSV
This is herpetic Whitlow from touching genital herpes.
I don’t think this is the case in real life, but UWorld says that you can see ____________ on the chest x-ray of someone with tamponade.
enlarged cardiac silhouette
I’ve read sources that say that acute tamponade occurs from as little as 150 mL which will not lead to noticeable cardiac enlargement on CXR.
Target PaO2 to a range of ___________ when a person is on a ventilator.
55 - 80 mm Hg (which usually corresponds to an SpO2 of 88% - 95%)
The initial HIV illness presents with LAD, pharyngitis, fever, ____________, ____________, and ____________.
arthralgia; GI upset (e.g., diarrhea, vomiting); mucosal ulcerations
Which three veins account for > 90% of PEs?
Popliteal, femoral, and iliac
Acute _____________ can cause a fourth heart sound.
coronary syndrome
It’s thought that the myocardial dysfunction can lead to the S4 sound.
____________ vaccines work by a T-cell-dependent B-cell respone.
____________ vaccines work by an independent B-cell response.
Conjugate protein (IgG PNA vaccine)
Polysaccharide (IgM PNA vaccine)
What physical feature can let you know that an ulcer is caused by pressure?
If it is over a bony protuberance: icshial tuberosity, trochanters, heal, metatarsal head, malleoli, etc.
___________ is caused by cytokine storage in RBCs before transfusion.
Febrile non-hemolytic reactions
This presents with fever and chills 1-6 hours after transfusion.
_____________ is caused by anamnestic antibody responses.
Delyaed hemolytic reaction
This is like the acute hemolytic reaction –which is caused by ABO incompatibility –but it is delayed because the antibodies develop later. Timeline = 2-10 days later.
Severe acute hemolytic transfusion reactions can cause ___________.
DIC
How do you treat acute hemolytic transfusion reaction?
Cease the transfusion and give fluids.
Antibiotics, hospitalization, and ___________ all increase the risk of Clostrioides difficile infection (yes, I’m a tool and I used the new nomenclature).
PPIs
True or false: alcoholic hepatitis causes transaminitis in the thousands.
False
Generally, transaminitis is in the hundreds (with the classic AST:ALT >2).
A young man presents with fulminant liver failure (evidenced by prolonged PT and hepatic encephalopathy) following an acetaminophen ingestion. What is the proper management?
Contact transplant surgery
True or false: post-partum thyroiditis is not antibody-mediated.
False
It is associated with anti-thyroid peroxidase antibodies.
Patients with many signs of acute limb ischemia –such as pain, pallor, parethesia, paralysis, pulseless, and poikilothermia –should be managed with ____________.
intravenous heparin
Although there are diagnostic studies that could confirm it (namely, Doppler US), you ought to start heparin first due to the risk of delayed diagnosis.
A woman learns that she is pregnant and states that she wants an abortion. Your office does not allow abortions secondary to its religious funding. Do you
a) Ask her why she wants an abortion?
or
b) Give her a list of other offices that provide abortions.
b)
I thought this was a little tricky because in most other question types the “tell me more why you want this procedure” answer is usually correct. UWorld clarifies that this response could be interpreted as trying to persuade the woman not to get an abortion, which is borderline unethical since this would be you imposing your beliefs on her.
The best antibiotic for uncomplicated bacterial sinusitis is _______________.
Augmentin
Increasing rates of beta-lactamase production among S. pneumoniae make clavulanic acid necessary.
A man presents three days after a CABG with post-operative mediastinits. The proper treatment for this is ________________.
surgical debridement and antibiotics
Cyanide poisoning can present with what CNS abnormalities?
Hyperreflexia due to thiocyanate accumulation
Which indicates earlier infection, anti-HBVc or anti-HBVe?
Anti-HBVc is earlier
Remember this is the window period.
Anti-HBVe is seen in the recovereeeeeee phase.
True or false: anti-HBVe antibody indicates a recovered past infection.
False
This antibody is seen in the recovery phase, but it actualy disappears in a fully recovered infection.
Anti-HBVc indicates a past infection.
Why do those with lobar pneumonia become hypoxemic when they lie on their affected side?
More blood is shunted to the dependent side and perfuses areas that are not ventilated.
How do you treat magnesium toxicity?
Stop the infusion of Mg (as most cases of hypermagnesemia are iatrogenic) and give calcium.
The most common predisposing factor for bacterial sinusitis is ______________.
viral URI
What is the nationally accepted guideline for physicians accepting gifts from pharmaceutical companies?
Only small, nonmonetary gifts that directly benefit patients are acceptable (per an AMA statement that is considered standard).
“Accentuate peripheral pulses” are seen in which congenital heart defect?
Patent ductus arteriosus
Glomerulonephritis, painful fingertip pads, and positive rheumatoid factor are seen in _______________.
infective endocarditis
The initial workup of lower-urinary tract obstruction includes urinalysis, urine cytology, BMP, and __________.
renal ultrasound (to look for hydronephrosis)
Before treating a man for low testosterone who has low LH/FSH, you need to _____________.
check prolactin levels; if this is normal, then you can treat with testosterone, but you need to rule out a prolactinoma first
If a person has lethargy and hyponatremia, you need to give them _______________.
3% hypertonic saline
Lethargy counts as AMS, which indicates rapid correction.
Describe the diagnosis and management of penile fracture.
- Penile fracture occurs when the tunica albuginea –which surrounds the corpus cavernosa –ruptures. This leads to an audible pop followed by rapidly spreading hematoma.
- Penile fracture needs to be managed with urgent operation. Because urethral injury can accompany penile fracture, you need to evaluate with a retrograde urethrogram if he has dysuria.
How should you treat paroxetine withdrawal?
Paroxetine withdrawal presents with malaise, GI upset, dysphoria, and neurologic symptoms (such as dizziness, tremors, and paresthesia). The best method to treat this is to reinstitute paroxetine and taper more slowly.
True or false: anaphylaxis affects the airway mainly through bronchospasm.
False
Laryngeal edema (an upper-airway obstruction) is the most common method of respiratory compromise in anaphylaxis.
A rapid spread of monomorphic papules on the shoulders, back, and upper arms might be what kind of drug reaction?
Steroid-induced acne
Systemic steroids can cause acne. The pattern is unique from other types of acne by the monomorphic appearance; non-drug-induced acne typically presents in various stages.
The best confirmatory diagnostic for bronchiectasis is ___________.
high-res CT
Describe post-cholecystectomy syndrome.
Occurring after a chole, this syndrome presents with pain similar to cholelithiasis. The bile duct should be evaluated for strictures or dilation.
