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Medicine Clerkship > UWorld Question Review > Flashcards

UWorld Question Review Flashcards

1
Q

Problem with amitriptyline in elderly men?

A

Anticholinergic activity can cause urinary retention, especially in elderly men because of BPH.
Prevents detrusor contraction and prevents urinary sphincter relaxation.

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2
Q

Most common complication of nephrotic syndrome?

A

Hypercoagulability due to loss of protein C and S, ATIII and platelet dysfunction.

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3
Q

Labs for paget’s disease?

Ca, phos, alkphos, hydroxyproline

A

Ca and phos are normal

Alkphos and hydroxyproline are increased

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4
Q

How to distinguish CML neutrophils from leukemoid reaction neutrophils?

A

Decreased leukocyte alkaline phosphatase because they’re functionally inactive.

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5
Q

Emphasematous Cholecystitis

A

Infection of gallbladder wall with gas forming bacteria (klebsiella, clostridium). Presents with gallbladder crepitus.

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6
Q

When to place IVC filter?

A

Contraindication to anticoagulation or anticoagulation failure in patients with DVT.

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7
Q

Can warfarin doses be restarted?

A

Yes if INR >2, no if less because will cause hypercoagulable state. Need to use heparin bridge.

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8
Q

How to treat central retinal artery occlusion?

A

Central retinal artery occlusion is caused by emboli from afib/cad/valvular disease, etc.

Treat with ocular massage and high flow oxygen.

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9
Q

How to evaluate a nonhealing ulcer that crusts at the margin of a former scar?

A

Probably squamous cell carcinoma, do a biopsy.

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10
Q

Arrhythmia pathognomonic for digitalis toxicity? Other symptoms?

A

Atrial tachycardia with AV block. Diarrhea, nausea, fatigue, yellow-green vision.

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11
Q

Cupping of the optic disk and loss of peripheral vision suggestive of?

A

Glaucoma

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12
Q

Quick test to diagnose Addison’s Disease?

A

Cosyntropin test. ACTH analog that should produce increase in cort but it doesnt if patient has addisons

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13
Q

Euthyroid sick syndrome

A

Asymptomatic decreased T3 after prolonged illness

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14
Q

Intensive glycemic control in type II diabetes has what effects?

A

Decreases microvascular complications, has no effect on macrovascular complications.

AIC less than 6 INCREASES all cause mortality.

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15
Q

Most common asbestos related malignancy?

A

Bronchogenic carcinoma

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16
Q

How does cold water help stop paroxysmal superventricular tachycardia?

A

Causes increase in vagal tone, helps break the SVT

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17
Q

How to treat penicillin sensitive organisms that cause infectious endocarditis?

A

Ceftriaxone or IV penicillin. NOT oral penicillin.

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18
Q

Theophylline toxicity

A

Can cause multifocal atrial tachycardia, seizures/headache, nausea/vomiting especially in conjunction with cipro.

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19
Q

Side effect of erythropoetin in ESRD patients?

A

Worsening of hypertension in 30-50%, headaches in 15%

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20
Q

Hydroxychloroquine side effect?

A

Eye damage.

Use hydroxychloroquine to treat for lupus.

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21
Q

Signs of AV shunting

A

High BP, huge pulse pressure, increased preload, increased cardiac output. High output cardiac failure because not enough circulating oxygen to meet demands.

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22
Q

Causes of secondary amyloidosis

A

Chronic inflammatory states

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23
Q

How to treat WPW?

A

Give Class 1 antiarrhythmic, don’t give any nodal blockers, they can cause vfib.

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24
Q

Enthesitis? Common cause?

A

Pain where tendons attach to bone. Seen in ankylosing spondylitis.

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25
Q

CURB-65

A

Confusion, uremia, respiratory rate >30, Blood pressure 65. 4+ ICU, 2+ inpatient,

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26
Q

What type of lung injury is due to crush injury?

A

Flail chest, which is contiguous broken ribs causing respiratory distress.

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27
Q

Febrile nonhemolytic transfusion reaction

A

Occurs between 1-6 hours after transfusion associated with chills and malaise. Caused by residual leukocytes in the plasma. Prevent by leukoreducing.

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28
Q

Cardiac Index? How does it change in heart failure?

A

CI is SV/total body surface area. Decreases in heart failure.

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29
Q

/Acid-Base derangement induced by AKI?

A

Metabolic acidosis

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30
Q

Acid-base derangement induced by loop diuretics?

A

Metabolic alkalosis.

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31
Q

Symptoms of prostatitis? Treatment

A

Shaking chills, fever, dysuria, perineal pain.

Boggy prostate.

Get a clean catch mid stream to isolate organism and treat, usually with bactrim or a fluoroquinolone for 4-6 weeks.

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32
Q

Acute limb ischemia post MI

A

Usually due to LV thrombi traveling to limb. Rule out LV mural thrombi with echocardiogram.

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33
Q

Distinguish chronic bronchitis from bronchiectasis? How to work up bronchiectasis?

A

Chronic bronchitis produces nonpurulent sputum. Bronchiectasis, the sputum is purulent and associated with fever, infections (pseudomonas), etc.

Work up with chest CT, then bronch/sputum analysis.

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34
Q

What is use dependence for antiarrhythmics

A

When heart rate increases, QRS complex will widen for people on class IC antiarrhythmics (Flecanide, Propafenone) because there is less time for drug to dissociate from Na channel.

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35
Q

Why isn’t lidocaine used during ACS?

A

May prevent Vfib, but also increases the chance of asystole.

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36
Q

Why does Crohn’s predispose to oxalate stones?

A

Because Fat malabsorption occurs, which binds Ca in gut stronger than oxylate, leaving oxylate unbound and free for increased absorption.

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37
Q

First change in diabetes nephropathy?

A

Glomerular hyperfiltration. First change that can be quantified is basement membrane expansion.

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38
Q

GI angiodysplasia

A

Frequent in elderly people with aortic stenosis or ESRD. Responsible for painless blood in stool and anemia.

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39
Q

Management of suspected PE: First step if PE likely?

A

Start IV heparin

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40
Q

Common side effect of CCBs?

A

Peripheral edema. Can give ACEi or ARB to lower risk of peripheral edema

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41
Q

Prognostic factor in TCA overdose?

A

Length of QRS

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42
Q

How to diagnose disseminated histoplasmosis?

A

With a urine antigen! Blood cultures used a confirmatory test because sensitivity is lower.

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43
Q

How to treat disseminated histoplasmosis?

A

Itraconazole

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44
Q

Cause of diarrhea in scleroderma?

A

Small bowel bacterial overgrowth due to slowed GI motility.

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45
Q

What to give to patients with neutropenic fever?

A

Anti-pseudomonal monotherapy with piperacillin-tazobactam.

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46
Q

When to vaccinate a traveler for Hep A?

A

When going to Asia/Africa

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47
Q 
Location of cysts in the mediastinum?
Thymoma
Bronchogenic cyst
Esophageal leiomyoma
Neuroblastoma
A

Thymoma is in anterior mediastinum
Bronchogenic cyst in middle mediastinum
Leiomyoma and neuroendocrine in posterior mediastinum.

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48
Q

HIV+ patient eye infections:

A

CMV: Fluffy retinal lesions
HSV: Keratoconjunctivitis, causes rapidly progressive vision loss. Very serious.

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49
Q

Causes of calcified adrenal glands leading to insufficiency?

A

Tuberculosis!

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50
Q

How to distinguish thyroid follicular carcinoma from follicular adenoma?

A

Invasion into the surrounding capsule.

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51
Q

How to treat PBC?

A

Ursodeoxycholic acid. Cholestyramine can treat pruritis, but doesn’t help with survival.

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52
Q

How to treat acute kidney rejection

A

IV steroids.

Symptoms are lymphocytic infiltration with vascular involvement and intimal swelling

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53
Q

How to f/u compensated cirrhosis

A

Liver US for HCC surveillance +/- AFP Q6mos, and EGD.

54
Q

Necrolytic migratory erythema

A

Erythematous papules or plaques that coalesce to form a painful large and inflammatory blister with a central clearing. Normally occurs in the perineum, extremities, and face. Caused by glucagonoma.

55
Q

Best intervention for hypercalcemia of malignancy?

A

Bisphosphonates.

56
Q

Common electrolyte abnormality after blood transfusions? Symptoms?

A

Hypocalcemia (due to chelation by citrate), increased DTRs.

57
Q

Most common cause of restrictive cardiomyopathy?

A

Amyloidosis

58
Q

How to check for androgen-producing adrenal tumors in females?

A

Check DHEA-S, which is produced in the adrenals and is converted to T.

59
Q

How is dipyridamole used in stress testing.

A

By maximizing coronary steal. Normal vessels dilate, but disease vessels don’t, creating angina.

60
Q

How to treat symptoms of bony mets to spine from prostate cancer?

A

Radiation

61
Q 
Side effect of HIV meds:
Didanosine
Abacavir
Any NRTI
any NNRTI
Nevirapine
Indinavir
A 
Pancreatitis
Abacavir hypersensitivity syndrome
NRTIs cause lactic acidosis
NNRTIs cause SJS
Nevirapine causes liver failure
Indinavir causes a crystal nephropathy
62
Q

Hyposthenuria

A

Complication of sickle cell disease that prevents kidney from being able to concentrate urine, causes diuresis.

63
Q

What vaccines do you give for splenectomy? When?

A

Meningococcus, PCV-13, HiB.

2 weeks before or 2 weeks after.

64
Q

Scleroderma renal crisis

A

Acute renal failure in patients with systemic sclerosis, accompanied by malignant hypertension and microangiopathic hemolytic anemia and thrombocytopenia

65
Q

Interstitial Cystitis

A

Painful bladder syndrome. Relieved by urination.

66
Q

Lupus anticoagulant

A

Increases PTT, causes thrombosis in vivo.

67
Q

How to treat PE in patients with severe renal insufficiency?

A

Can’t use fondaparinux, enoxaparin, or rivaroxaban if GFR

68
Q

Pathognomonic sign of factitious diarrhea on colonoscopy

A

Brown discoloration of colon with prominent lymph follicles showing as pale patches. Signs of laxative abuse

69
Q

Most sensitive test to evaluate esophageal dismotility disease?

A

Barium esophagram.

70
Q

Treatment of malignant hypertension in a patient with pheochromocytoma?

A

ALPHA BLOCKERS first, then beta blockers.

B without A causes increase in BP.

71
Q

How do mets from cancer cause hypercalcemia?

A

By producing PTHrP. NOT by directly stimulating release from bone.

72
Q

Two prominent causes of ITP that should be tested for whenever patient has thrombocytopenia?

A

HCV and HIV

73
Q

Most important step in the management of HHNK?

A

Fluid replacement. Give NS.

Can give insulin if not responding.

74
Q

How do large pericardial effusions present?

A

Water bottle heart with nonpalpable PMI. JVD seated.

75
Q

How does estrogen affect requirement for levothyroxine?

A

Increases need because estrogen increases TBG.

76
Q

Morton Neuroma

A

Foot injury common in runners that causes numbness and pain between the 3rd and 4th toes. Also clicking sound. Not a true neuroma but due to degeneration of nerves.

77
Q

Radiographic evidence of aortic dissection? Best diagnostic test?

A

Mediastinal widening. Diagnose with TEE.

78
Q

TMP-SMX effect on kidney?

A

Inhibits ENac so can cause hyperkalemia. Also prevents tubular secretion of creatinine so can cause increase in serum creatinine without changing GFR.

79
Q

How to treat reactive arthritis?

A

NSAIDS. Happens after GC is treated.

80
Q

Most likely consequence of untreated hyperthyroidism?

A

Bone loss. Directly stimulates osteoclasts to resorb bone.

81
Q

SJS vs TEN

A

SJS involves 30%

82
Q

Lifestyle modification to prevent oxalate stones?

A

Decrease protein in diet

83
Q

How to treat suspected TTP? Symptoms?

A

Hemolytic anemia, decreased platelets.

Treat with plasmaphoresis to remove antibody suspected.

84
Q

How to treat hyponatremia due to SIADH?

A

Hypertonic saline if very severe.

85
Q

Electrolyte abnormalities with tumor lysis syndrome?

A

Decreased calcium, increased phosphate, increased potassium, increased uric acid.

As cells lyse, K and phos are released. Phos binds calcium, which causes hypocalcemia.

86
Q

Some drugs that can cause crystal induced nephropathy?

A

Acyclovir, indinavir, methotrexate, sulfonamides.

87
Q

How to investigate esophageal spasm?

A

Manometry.

Esophageal spasm is precipitated by food and emotional stress, radiates to the back, and responds to nitrates.

88
Q

What to do about renal cysts?

A

If single, simple, unilocular, just wait

If thick. irregular, loculated with septae, contrast enhancing, then follow up imaging.

89
Q

Complication of high PEEP ventilation?

A

Tension pneumothorax

90
Q

Disease acquired through contact with sandboxes?

A

Cutaneous larva migrans (ancylostoma braziliense). Causes pruritic elevated serpiginous lesions on skin.

91
Q

Persistent left sided varicocele in older male concerning for? How to evaluate?

A

Renal cell carcinoma, evaluated with an abdominal CT scan

92
Q

Femoral bowing a sign of what disease?

A

Paget’s disease caused by osteoclast hyperfunction.

93
Q

Complication of severe bronchiectasis?

A

Hemoptysis

94
Q

Difficulty breathing in ankylosing spondylitis?

A

Due to chest wall movement abnormalities. PFTs show restrictive pattern.

95
Q

PCWP and mixed venous O2 sat in septic shock

A

PCWP normal, MVO2 high because of decreased ability of tissues to extract O2 and improper distribution of cardiac output.

96
Q

Poor prognostic sign for CLL? Characteristic cell?

A

Thrombocytopenia. Characteristic cell is the smudge cell.

97
Q

How to diagnose OA on history alone (6 criteria)

A

Age>50, no morning stiffness, bony crepitus, bony enlargement, bony tenderness, no warmth at joint

98
Q

How to test for G6PD deficiency?

A

Send an enzyme level, but may be false negative during an acute episode of hemolysis.

99
Q

Common side effect of methimazole +propylthiouracil? Symptoms?

A

Agranulocytosis. Stop drug if patient develops fever and sore throat.

100
Q

When to give PEP for rabies?

A

If bitten by a high risk animal (raccoon, bat, skunk, fox, coyote), or if by bitten by a dog, cat, or ferret that shows signs of rabies after 10 day quarantine.

Do not give PEP for low risk animal bites (squirrel, chipmunk, rat, mouse, rabbit).

101
Q

How do thiazides affect glucose metabolism?

A

Cause metabolic syndrome and hyperglycemia.

102
Q

pH of transudate vs exudate pleural effusions

Empyema?

A

Transudate 7.45-7.55

exudate 7.3-7.4

103
Q

How to treat dermatitis herpetiformis

A

DAPSONE

104
Q

Consequence of poorly treated Hashimoto’s Thyroiditis?

A

Lymphoma of thyroid.

105
Q

How to treat hairy cell?

A

Cladribine

106
Q

Medication induced hypothyroidism:

A

Amiodarone

107
Q

CHF in young patient suggests?

A

Dilated cardiomyopathy due to cocksackie b

108
Q

Long term complication of pernicious anemia?

A

Gastric cancer from atrophic gastritis

109
Q

Symptoms of thyroid storm

A

fever, tachycardia, tremor, arrhythmias.

Generally happens after surgery, trauma, infection.

110
Q

Next diagnostic step in recurrent pneumonias?

A

CT to assess for structural damage

111
Q

How to treat uric acid stones?

A

Alkalinize the urine with potassium citrate.

112
Q

Best drug for increasing appetite in cachectic patient?

A

Megestrol acetate (progesterone derivatives)

113
Q

First step in work up for suspected BPH?

A

First step is to obtain urinalysis and get a PSA for men with life expectancy >10 years.

114
Q

Which vitamin deficiency is caused by carcinoid syndrome (flushing, new murmur, diarrhea)?

A

Niacin deficiency because it’s used to make 5-HT.

Causes pellagra (dermatitis, diarrhea, dementia).

115
Q

Contraindication to succinylcholine use?

A

Hyperkalemia because succinylcholine causes K release

116
Q

Best treatment for hyperthyroidism?

A

radioactive iodine ablation

117
Q

Most common extraarticular manifestation of ankylosing spondylitis?

A

Anterior Uveitis`

118
Q

How to treat stemi patient who presents with pulmonary edema?

A

IV furosemide, avoid beta blockers in these patients.

119
Q

Renal tubular acidosis IV

A

Causes a non-gap metabolic acidosis secondary due insensitivity to aldosterone in elderly men. This is normally due to poorly controlled diabetes.

120
Q

How to treat lyme in a pregnant woman?

A

Ampicillin

121
Q

Symptoms of polymyalgia rheumatica? how to treat?

A

Elevated ESR, neck, shoulder, back pain

Treat with low dose steroids

122
Q

What to do with new onset of SLE?

A

Kidney biopsy before any treatment

123
Q

Symptoms of beta blocker overdose?

A

Bradycardia with first degree heart block and WHEEZING.

Treat with IVF and atropine. Refractory? Then use glucagon.

124
Q

Ludwig Angina

A

Cellulitis in the submandibular region from a tooth infection. Crepitus present.

125
Q

Supplement for people with sickle cell?

A

Folate due to increased turnover and production of RBC.

126
Q

What causes proximal muscle weakness with tremors?

A

Hyperthyroidism

127
Q

Keratitis vs conjunctivitis?

A

Keratitis involves the cornea, conjunctivitis doesn’t.

128
Q

Renal vein thrombosis is seen most commonly in which nephrotic syndrome?

A

Membranous

129
Q

Dangerous side effect of furosemide?

A

Hearing loss

130
Q

Perivalvular abscess

A

Presents with a patient with endocarditis and new conduction abnormality.

Medicine Clerkship (12 decks)

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