UWorld Q Bank: Week of 05/07/18 Flashcards
Terminal hematuria – bleeding at the end your stream –is typical of ____________ hematuria.
bladder/prostate/ureteral
True or false: ivermectin can be used to treat Enterobius vermicularis infections.
False
Ivermectin (though it is used in the Sketchy scene with Enterobius) is used for Strongyloides infections. Albendazole is the treatment for Enterobius.
True or false: “rambling, difficult-to-follow speech” is typical of mania.
False
This is more typical of schizophrenia’s incoherent speech.
What disorder is suggested by these findings?
- Macular erythroderma
- Hypotension
- Fever
- Desquamation
- MOF (e.g., AKI, transaminitis, AMS, GI involvement, thrombocytopenia)
Toxic shock syndrome
A woman with no prenatal care delivers an infant who is SGA but otherwise has a normal physical exam. What workup should you do?
Send the placenta for histopathologic exam. This can show infection or infarction.
If a woman endorses suprapubic pain that shoots down the legs after labor, she likely has ______________.
pubic symphisis diastasis
This is a condition in which the anterior part of the pelvis is stretched during delivery (particularly during traumatic deliveries or those with macrosomic babies). It usually goes away with rest and conservative management.
To do the hepatojugular reflex properly, you need to hold pressure for _________.
10-15 seconds
A new right bundle-branch block and hypotension in the postoperative setting could be a right-sided MI or ____________.
a PE
Look for non-specific ST changes and hypoxemia.
Describe renal cysts.
•Renal cysts are commonly seen on abdominal CTs. Complex cysts need to be evaluated further, whereas simple cysts can be left alone. • Complex features: - Irregular border - Thick border - Septations - Heterogeneous - Symptomatic - Contrast enhancing •Simple features; - Smooth border - Thin border - No septations - Homogeneous
How much does smoking cessation lower BP?
Almost not at all. Light smokers actually have lower BP on average than non-smokers.
Here are the best lifestyle methods to lower BP:
- Weight loss: 5-20 mm Hg per 10 kg lost
- DASH diet: 8-14 mm Hg
- Exercise: 4-9 mm Hg
- Dietary sodium restriction to less than 3 g/day: 2-8 mm Hg
- Alcohol intake less than 2 drinks/day: 2-4 mm Hg
Which electrolyte abnormality can precipitate hepatic encephalopathy?
Hypokalemia
Hypokalemia leads to an intracellular acidosis (because more H+ are available to be pumped into the cell) which then generates more ammonia production. (Ammonia is an intracellular buffer.)
Which acid-base disturbance can lead to hepatic encephalopathy?
Metabolic alkalosis
This leads to the generation of NH3, which can enter the CNS, from NH4.
Fatty liver can be caused by which medications?
- Valproate
- Tetracycline
- HAART
Depot progesterone is injected every _________.
3 months
Compared to most formulas, breast milk is ______________.
more easily absorbed by the GI tract (because it is higher whey content than most formulas)
The strongest impulse for expansion of AAAs is ______________.
smoking status
This is more powerful than uncontrolled HTN in promoting AAA growth.
Describe how intermittent strabismus depends on age.
- Intermittent strabismus is common in the first 4 months of life. This is best managed by watchful waiting. If it is persistent then you need an ophthalmologic evaluation ASAP.
- Intermittent strabismus after 4 months needs to be corrected by patching the unaffected eye.
How late can chlamydial conjunctivitis present?
14 days
It can also be very mild, so even scant mucopurulent discharge should be treated with oral erythromycin.
___________ is when the conjunctivae stick to the eye.
Chemosis
__________ is a potential complication of diverticulitis. Turbid urine is a classic finding.
Colovesical fistula
Diagnose with CT with oral contrast showing bladder enhancement.
Milk-alkali syndrome presents with this triad: hypercalcemia, metabolic alkalosis, and ___________.
AKI
Type 4 RTA is caused by _________ aldosterone.
low
What disorder makes CKD more likely to turn into RTA 4?
Diabetic nephropathy
CKD needs to be advanced to cause metabolic acidosis (GFR < 20). Diabetic nephropathy damages the mesangium and leads to a low-renin state, which raises the risk of RTA 4.
“Catching of the knee” –meaning a temporary inability to fully extend it – is a symptom of _________.
mensical tears
What should you do if you have a high suspicion of meniscal tear but the person has a benign exam?
MRI
The McMurphy test has a high specificity but low sensitivity, so a person with a history suspicious for meniscal tear (e.g., rotational injury, catching of the knee, pain with weight bearing) should get an MRI.
What is panendoscopy?
Laryngoscopy, esophagoduodenoscopy, and bronchoscopy
Panendoscopy is useful when you find a neck lymph node with cancer.
The best choice for UTI antibiotic in nonpregnant women is _____________.
nitrofurantoin for 5 days
Second choice: Bactrim for 3 days.
Levofloxacin is reserved for resistant cases.
____________ toxicity can lead to GI upset, tremor, ataxia, and seizures.
Lithium
Look for the stem that has a person on Li who starts taking HCTZ.
How does focal nodular hyperplasia differ from hepatic adenoma on imaging?
FNH is caused by increased arterial bloodflow, so Doppler can show an area with increased vasculature. Central necrosis is also seen in FNH.
Otitis externa can lead to what serious complication?
Malignant otitis externa, in which the infection spreads to the bones of the skull
C BIG K is reserved for patients with ______________.
ECG changes or rapidly rising potassium (from tissue destruction or acute renal failure)
The B in CURB-65 is ____________.
BUN > 20
How should you evaluate esophageal perforation in a person with caustic ingestion?
1) CXR with gastrograffin
2) Endoscopy
If a woman has Sjögren’s symptoms (dry eyes and mouth) that are mild and start in her 70s, then this is likely ___________.
age-related sicca syndrome, a condition in which the exocrine glands atrophy
Primary syphilis presents with painless chancres.
Secondary syphilis presents with a diffuse maculopapular rash (including palms and soles), condyloma lata, ________, __________, and ___________.
hepatitis; oral lesions (gray ulcers); lymphadenopathy (particularly epitrochlear, which is the area just superior to the medial epicondyle)
The most specific sign of opioid intoxication is ______________.
decreased RR
Rhinorrhea and desquamating rash of specific to which congenital infection?
Syphilis (just like secondary syphilis)
The Kleihauer-Betke test is used to determine ______________.
how much fetal blood has entered the maternal circulation in a Rh-incompatibility pregnancy
EPO is usually titrated to a goal Hgb of ___________ in those with CKD-related anemia.
10-11
Acute transplant rejection –evidenced by elevated creatinine/BUN, flank tenderness, oliguria, and normal cyclosporine levels in the post-operative period –is treated with _____________.
IV steroids
Remember that cyclosporine toxicity can also occur, though it does not cause flank tenderness and usually presents with an elevated cyclosporine level.
Remember, the cause of febrile nonhemolytic reactions is ______________.
stored cytokines/leukocyte debris in RBCs
Review the symptoms/signs of sarcoidosis.
- Granulomas
- aRthralgias
- Uveitis
- Erythema nodosum
- LAD
- Infiltrate of organs (hepatomeglay, splenomegaly, hypopituitarism, restrictive cardiomyopathy)
- Nerve palsy
- ACE elevations and Ca elevations
- Fever
It’s GRUELIN’ AF to remember the sarcoid signs.
True or false: ARDS needs to have a PaO2:FiO2 ratio < 200.
False
It is less than 300.
Preventing ____________ has been shown to reduce mortality in ARDS.
alveolar overdistension (using low tidal volume)
_____________ is frequently undiagnosed and untreated in those surviving strokes.
Depression
Research shows improved outcomes (both psychiatric and otherwise) with SSRI therapy for those showing signs of depression after a stroke.
Which medicine permanently increases exophthalmos in those with Graves disease?
Radioactive iodine
Coadministratrion with prednisone can prevent this, however.
(Think of radioactivity making you have lasers shoot out of your eyes.)
Restrictive cardiomyopathy and hypertrophic cardiomyopathy can look very similar: S4, edema, and concentric hypertrophy are features of both. How can you differentiate the two?
Look for features unique to each:
- Hypertrophic cardiomyopathy: long history of HTN
- Restrictive: no history of HTN, proteinuria, waxy skin, easy bruising, organomegaly, early satiety, history of infiltrative disorders (e.g., sarcoidosis, hemochromatosis, MGUS)
If daytime symptoms occur greater than _______, you need to increase asthma medications.
2 times per week
Nighttime symptoms no greater than twice monthly.
Flank pain with alternating episodes of oligura and polyuria suggests ____________.
obstructive uropathy (likely due to a stone)
This is more common in a patient with one kidney, but can happen in those with two kidneys if the obstruction blocks the urethra. When the obstruction relieves (which can happen in a ball-valve situation), you can get post-obstruction diuresis which can even cause hypokalemia.
In a patient with a spinal cord injury, you need to insert a _____________ once they have been stabilized.
bladder catheter
If a person has evidence of neurologic injury above the nerves that innervate the bladder, then you need to ensure they don’t develop neurogenic bladder (which could be very serious if the bladder ruptured).
