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).
True or false: give physostigmine to reverse organophosphate poisoning.
False
This would worsen the poisoning. Remember that atropine and pralidoxime treat organophosphate toxicity.
In addition to administering antidote, ___________ if important in treating organophosphate poisoning.
external cleaning
This is important because the ingested organophosphate can be reabsorbed through the skin.
True or false: Chlamydia causes painful ulcers with painless LAD.
False
It’s the opposite: painless ulcer with painful LAD.
By physical exam, how can you differentiate leukocytoclastic vasculitis and Kaposi sarcoma?
LV turns brown/red after time, wheras KS stays violaceous.
Erythrocytosis and varicocele are suggestive of ____________.
RCC
If a person has an obstructive liver pattern but a non-dilated biliary duct, then they have ______________ (broadly speaking).
intrahepatic cholestasis
A young woman presents with intermittent exertional chest pain. Her EKG is normal. Her vitals are normal except for a discrepancy between the right and left arm BP, with left being less. What is the likely pathology?
Supravalvar aortic stenosis
In this disease, the aorta tapers just above the valve. Because of this, blood is preferentially shunted into the innominate artery and causes HTN in the right arm. Concentric hypertrophy usually develops because of increase work.
How should you manage a pregnancy with a non-viable fetus?
All efforts are aimed at minimizing maternal mortality. As such, you can do an abortion –if she wants –or NSVD.
Important fact: NSVD has less of a chance of maternal complications.
Engorgement and plugged ducts both present with breast tenderness and warmth. How can you use physical exam to differentiate the two?
Engorgement presents with bilateral, uniform breast enlargement and tenderness. Plugged ducts are usually focal; that is, only one duct is blocked, so unless it’s the central duct then it will only affect part of the breast.
What causes breast engorgement?
When the colostrum is replaced by milk
Treat with cool compresses and acetaminophen.
List the two steps in diagnosing meconium ileus.
1) Abdominal x-ray (to look for obstruction and free air)
2) Contrast enema (to differentiate between Hirschprung’s and other causes of meconium ileus)
Medulloblastomas usually cause what focal neurologic deficit?
Truncal ataxia
Medulloblastomas usually arise in the cerebellar vermis, the area responsible for truncal coordination.
Losing 10 kg can lead to up to ______ mm Hg decrease in systolic BP.
20
Patients with what congential valvular disorder have the highest risk of infective endocarditis?
Mitral valve prolapse and mitral regurgitation
The risk is 8x higher.
UWorld says that after _____________, hospitalized patients with endocarditis can be switched to oral abx.
48 hours and a positive culture
Beta-blockers have been shown to decrease mortality in those with MIs. When would you not give a BB, though?
When the person has acute decompensated heart failure, bradycardia, or a right-sided MI
If the person has any of these things, BBs will trigger acute worsening of their HF.
A person with an MI develops flash pulmonary edema secondary to acute heart failure. The treatment?
Furosemide
Fever, tenosynovitis, arthralgia, and pustules are suggestive of ________________.
gonococcemia
Intriginous or axillary furunculosis with deeper fibrosis in a chronic pattern is ________________.
hidradenitis suppurtiva
Pregnant women ≥35 years old should be offered ______________.
cell-free DNA screening at 10 weeks
What is the treatment for DVT in those with ESRD?
Unfractionated heparin followed by warfarin
You suspect chronic leukemia based on history and CBC. What is the next diagnostic?
Flow cytometry (looking for clonal proliferaiton of B cells)
A puncture wound that leads to osteomyelitis is likely from what etiology?
Pseudomonas aeruginosa
Other than the vitamin-related effects, pernicious anemia raises the risk of __________.
gastric cancer
The loss of intrinsic factor leads to a chronic atrophic gastritis. This increases the risk of future cancer.
How do you treat pulseless electrical activity?
- CPR (to maintain cardiac output)
- IV access and fluids (to help perfuse end organs)
- Epinephrine (to maintain cerebral perfusion)
- Scan for shockable rhythm every 2 minutes (in case they transition to ventricular fibrillation)
What are the four most common causes of hypoparathyroidism?
1) Post-surgical (after a thyroidectomy)
2) Autoimmune destruction
3) Congenital absence (DiGeorge)
4) Defective calcium sensor
____________ is the most useful therapy in treating pain from bone metastasis.
Radiation therapy
How do you establish the diagnosis of Cushing syndrome.
Two of these tests must be positive:
• Late-night cortisol (high is positive)
•24-hour urinary cortisol
•Dexamethasone suppression test
True or false: prophylaxis against fungal infections is not indicated at any stage of AIDS.
False
Those living in Histoplasma-endemic areas with CD4s < 150 should take itraconazole.
What test is commonly negative in disseminated gonococcemia that you would expect to be positive?
Blood cultures
Less than 1/3 of those with disseminated gonococcemia have positive cultures. NAAT of mucosal surfaces (particularly the genital tract) are usually positve, however.
The key difference on CT between lymphoma/toxoplasmosis and PML is _____________.
that PML causes non-enhancing lesions, while the other two causes enhancing lesions
Reye syndrome presents with what on pathologic exam of the liver?
Microvesicular steatohepatitis
Think of the tiny spots on the cow in the Sketchy scene.
What is a CYP inhibitor that for sure was never on Step 1, the shelves, or anywhere in the preclinical years?
Acetaminophen
Taken at high doses (>2 g/day) for a long time can inhibit CYP450.
A newborn delivered via c-section has grunting, nasal flaring, and tachypnea, but his exam is otherwise normal. What is the likely cause?
Transient tachypnea of the newborn, caused by failure to clear amniotic fluid from the lungs (which is assisted by vaginal labor)
Intensive glycemic control (A1c < 6.5%) has been shown to reduce _____________ complications.
microvascular (i.e., nephropathy, retinopathy)
No benefit to macrovascular (e.g., PAD, CAD, CVA) has been shown.
Clicking when pressing the 3rd and 4th metatarsals along with pain or numbness in this distribution is suggestive of _______________.
motor neuroma
This is not a true neuroma, but is rather a degeneration of the nerve that runs between the tarsals caused by intense running. Treatment involves supporting the distal tarsals with better shoes.
Tarsal tunnel syndrome is _______________.
compression of the tibial nerve at the heel with numbness, pain, and tingling radiating through the plantar surface of the foot
Cyclosporine toxicity can cause renal failure, ________, and ___________.
CNS disturbances (seizure, AMS); gingival hypertrophy
It’s important to know this because tacrolimus toxicity can cause AKI as well, but does not cause ginigval hypertrophy.
Remember, when you get a question about metabolic acidosis and respiratory compensation, use _____________.
Winter’s formula to see if the respiratory compensation is adequate
The pH in ASA toxicity is usually __________.
normal because of the opposing problems
Explain the process of mandatory reporting of HIV to those exposed.
If a person refuses to tell his or her sexual contacts about their risk of having contracted HIV, the health department will contact them and let them know that they have been exposed without identifying the person who has HIV.
Edema that is caused by venous insufficiency has what typical features?
- Worse in the evening
- Ulcers on medial malleoli
- Otherwise euvolemic with normal cardiac exam
True or false: hydroxyurea has been shown to benefit those with beta thalassemia.
False
Most people develop atrial fibrillation from ___________ in rheumatic heart disease.
left atrial enlargement
Importantly, fibromuscular dysplasia can also affect ____________.
the cerebral vessels, leading to carotid bruits and amaurosis fugax
An evenly decreased FEV/FVC with a normal DLCo indicates?
Chest wall problems
Wernicke encephalopathy is associated with alcoholis, chronic malnutrtion, and ____________.
hyperemesis gravidarum
Acute fatty liver of pregnancy most often presents in the _____________ trimester.
third
Describe the pathophysiology of Paget disease of the bone.
Aberrant activation of osteoclasts
Low potassium, high blood pressure, and ________ bicarbonate are suggestive of aldosterone-secreting tumor.
high
It’s basically contraction alkalosis.
What are the AAP’s guidelines on vitamin D supplementation?
All exclusively breastfed infants should be started on 400 IU vitamin D within the first month of life.
____________ supplementation should be started at birth and continued until age 1 for all preterm infants.
Iron
What disease is suggested by the following features? •Macrocytic anemia •Triphalangeal thumbs •Webbed neck •Cleft lip
Diamond-Blackfan anemia
Tinea versicolor often presents after what activity?
Anything involving sun exposure
The surrounding tan highlights the hypopigmentation.
In addition to hypopigmentation, _____________ can occur with tinea versicolor.
pruritus
Acalculous cholecystitis can present after hemorrhage, sepsis, or _____________.
serious surgery (like cardiopulmonary)
Normal _________ do not exclude acalculous cholecystitis.
LFTs
Although all nephrotic disorders lead to a hypercoagulable state and can cause renal vein thrombosis, _____________ is most commonly associated with RVT.
membranous nephropathy
“membrANous causes low ANtithrombin.”
The preferred way to screen for diabetic nephropathy is _________________.
urine microalbumin:creatinine ratio
Describe the physical exam maneuver used to diagnose gastric outlet obstruction.
Listening to the patients epigastric area while they move back and forth can diagnose gastric outlet obstruction. A positive sound is a splashing sound > 3 hours after eating.
A dull, hypomobile tympanic membrane –serous otitis media –might be seen in those with ____________.
HIV
LAD and lymphoma can occlude the Eustachian tube in those with HIV and cause serous otitis media. SOM is diagnosed by the previously described findings along with hearing loss and absence of inflammatory signs.
5-FU is only used in ______________.
superficial, mild cases of BCC or actinic keratosis
Anterior uveitis can result from what kind of injury?
Globe-penetrating injury to the contralateral eye
The uncovering of hidden antigens leads to immune activation against the spared eye.
How would you diagnose a hypopigmented, anesthetic lesion?
Biopsy the edges of the wound –this is likely leprosy
A normal opening pressure is less than _____________.
18 cm
Remember that serum Ca > _____ units above normal range is satisfatory criteria for surgical intervention.
1
Aspirin, nitrates, CCBs, and ____________ should be given to those having cocaine MIs.
IV benzodiazepines
Prior to causing aortic-stenosis murmurs, __________ can be heard in those with congenital bicuspid aortic valve.
aortic regurgitation
Heard at the left sternal border, 3rd/4th intercostal space
____________ can be given early on in APAP overdoses.
Activated charcoal
Other than age, what symptom can help you differentiate E. coli vs. N/C as causes of epididymitis?
Dysuria is seen in those with E. coli epididymitis, but not in that from N/C.
Describe the difference between Parkinson disease dementia and dementia with Lewy bodies.
They are the same disease –characterized by Parkinsonism, hallucinations, REM sleep disorders, and executive dysfunction –but in PDD the movement symptoms come first while in DWLB the non-movement symptoms come first.
These three things can decrease the likelihood of developing renal calculi: _________________.
increased hydration, decreased sodium intake, normal calcium intake
High intake of sodium can cause hypercalciuria due to interactions in the thick ascending loop of Henle: the sodium competes for the same receptors as calcium, so higher concentrations of sodium outcompete calcium and lead to increased calcium delivery to the renal calyces.
A pleural effusion that has “minimal layering on lateral decubitus film” may be loculated or ____________.
just small volume
Suspect loculations if the person appears toxic or has compromised respiratory status. If the person appears ok, then this is likely a mild parapneumonic effusion that can be treated with oral antibiotics without need of thoracentesis.
What treatment options are available for vitiligo?
- Limited area: topical steroids
* Widespread: PUVA, oral steroids, immunomodulators
If you’re already treating a person for suspected infection with antibiotics, why do you need to consider septic thrombophlebitis?
Because septic thrombophlebitis is treated with anticoagulation, too
