UWorld Qs: Week of 02/11/18 Flashcards
Describe the management of actinic keratosis.
Lesions that are larger than 1 cm, have ulcerations, or appear indurated should be biopsied to rule out malignancy. Lesions without those features can be treated with cryotherapy.
Review the treatment of meningitis in adults (immunocompetent, immunocompromised, and older than 50).
- Immunocompetent: ceftriaxone, vancomycin, and steroids
- Immunocompromised: cefepime, vancomycin, ampicillin, and steroids
- > 50: ceftriaxone, vancomycin, ampicllin, and steroids
In treating DKA, add iV potassium when _____________.
potassium is less than 5.2 (hold insulin when it hits 3.3)
The two most common causes of hyperkalemia are _________________.
kidney disease (acute or chronic) and aldosterone-inhibiting drugs
What pattern of T3, T4, and TSH is typical of euthyroid sick syndrome?
- Normal T4 and TSH
* Low T3
After NSAIDs, the next treatment for RA is _______________.
methotrexate
Only progress to other agents (etanercept, infliximab, etc.) when methotrexate fails.
The best test for diagnosing chronic pancreatitis is _____________.
CT scan
Lipase and amylase can be elevated, but they are not in many cases.
Enlarging nodules or ulcers at the site of an injury (like a graft or burn) are likely ________________.
Marjolin ulcers (SCC)
A patient had a drug-eluting stent placed and developed a STEMI four months later. What likely happened?
Drug noncompliance
Dual-antiplatelet therapy is indicated in the setting of stenting. Discontinuing this therapy has been shown to precipitate CAD.
Review the presentation, workup, and treatment of paroxysmal nocturnal hemoglobinuria.
Presentation:
- Hematuria at night
- Fatigue
- Hypercoagulable state
Workup:
- CBC showing hemolysis (anemia, elevated LDH, and decreased haptoglobin)
- Flow cytometry showing absence of CD55 and CD59
Treatment:
- Eculizumab (antibody to complement)
A young man is involved in an MVC and develops respiratory distress afterward. CXR shows bilateral infiltrates. What is the likely diagnosis?
Pulmonary contusions with flail chest
_____________ can appear after an MVC and might look like a hemothorax on CXR.
Diaphragmatic tear
It is more common on the left side because the liver is protective. Look for the g-tube in the chest.
________________ are treated with topical lidocaine and topical nifedipine.
Anal fissures
Limiting what two perioperative things can help prevent prolonged postoperative ileus?
•Opiates
* Fluids (overuse of which can cause bowel edema)
What bacteria is the most common cause of prosthetic joint infection?
S. epidermidis
Note, however, that infections within 3 months of surgery or after 12 months of surgery are more likely to be S. aureus.
Supracondylar fractures frequently injure what nerves?
Median nerve and radial nerve
Explain the pathophysiology of dumping syndrome.
Loss of the pyloric sphincter (from gastric bypass surgery) leads to rapid dumping of hypertonic contents into the small intestine which pulls fluid from the vessels into the intestinal lumen.
Compartment pressure greater than _________ is diagnostic of compartment syndrome.
30 mm Hg
What is a big caveat on the “painless jaundice” rule of pancreatic adenocarcinoma?
It means no RUQ biliary colic!
Most patients with pancreatic cancer actually have pain, but it is gnawing, constant epigastric pain –not the colicky RUQ pain of cholelithiasis.
How does AAA rupture lead to hematuria?
Bleeding of the aorta can accumulate into the retroperitoneum, leading to an aortocaval fistula. Increased caval pressure leads to increased pressure in the bladder veins which can rupture.
A patient with suspected TB develops gross hemoptysis. What is the initial management?
1) Place the bleeding lung in a dependent position
2) Bronchoscopy
A woman has peritoneal signs. Her history is significant for NSAID use and moderate alcohol use. Your suspicion?
Perforated ulcer
A guy gets an AAA repair and then colonoscopy shows ulcerations in the rectosigmoid junction. Diagnosis?
Ischemic colitis
The ulcerations can result from tissue friability.
PMS usually resolves during the _____________ phase.
follicular
How does cavitation appear on a chest x-ray?
Blacked out area (because there is no tissue)
Give differentials for painful vision loss and painless vision loss.
Painful vision loss:
- Acute angle-closure glaucoma
- Optic neuritis
Painless vision loss:
- Retinal vein occlusion
What is amaurosis fugax?
Temporary loss of vision due to emboli
(Even though amaurosis fugax results from emboli from carotid atherosclerosis, think of Amaurosis Fugax from Atrial Fibrillation to remember that it is emboli.)
Differentiate aplastic crisis from aplastic anemia.
- Crisis: only RBCs down
* Anemia: all blood cells (pancytopenia)
In addition to thiazides and NSAIDs, ____________ can also trigger lithium toxicity.
volume depletion
Look for the story of vomiting and diarrhea.
Multifocal atrial tachycardia is associated with ________________.
severe pulmonary disease causing cor pulmonale
The most common arrhythmia caused by digitalis toxicity is ________________.
atrial tachycardia with AV block
Delayed and soft pulses, mid-to-late systolic murmur, and _______________ are all findings of aortic stenosis.
soft S2 (because the aortic valve is frozen shut and doesn’t close, thus leaving a S2 made only of the pulmonic valve closing)
Gigantic whitish swellings of the finger joints are likely _______________.
tophaceous gout
In what position is S3 best heard?
Apex in the left-lateral decubitus position
A man undergoes a cardiac catheterization and then develops hypotension and tachycardia. He denies chest pain and SOB. The arterial access site looks unremarkable. What test should you do?
Stat non-contrast CT
Catheterization can cause retroperitoneal bleeding even with a normal-appearing femoral access site.
What three things make burns susceptible to infection?
- Avascular
- Immunologically devasted (due to injury to local WBCs)
- Protein rich
Umbilical hernia is associated with what three systemic conditions?
- Beckwith-Wiedemann
- Ehlers-Danlos
- Hypothyroidism
What should you do if you suspect rib fracture but the chest x-ray is negative?
Treat the same (i.e., with adequate analgesia)
Up to half of rib fractures don’t appear on x-ray.
True or false: increased BUN/creatinine ratio is suggestive of post-renal kidney injury.
False
BUN is reabsorbed more in a low-volume state, so increased BUN/creatinine ratio is suggestive of prerenal azotemia.
If you’re worried about a splenic injury (e.g., BAT with LUQ tenderness and anemia) and the FAST is negative, you should do ________________.
an abdominal CT
A woman presents with pneumoperitoneum and INR of 2.5 from warfarin therapy. What do you do before surgery?
Give FFP
What is the difference between intra- and extraperitoneal bladder injury?
- Intraperitoneal: injury to the dome of the bladder which is intraperitoneal and thus causes urine to leak into the peritoneum (look for peritonitis)
- Extraperitoneal: injury to the sides or rear of the bladder which are retroperitoneal and will not cause peritonitis
Hypocalcemia causes _________ QT.
prolongation of the
How will tamponade appear on a chest x-ray?
It won’t.
The small amount of blood needed for tamponade (100 - 200 mL) will not distort the cardiac silhouette.
