Uworld questions #2 Flashcards
What are symptoms of someone OD on diphenhydramine? What’s the treatment?
Diphenhydramine is an anti-histamine with anticholinergic properties. OD presents with drowsiness and confusion 2/2 to anti-histamine effects and dry mouth, dilated pupils, blurred vision, bowel and urinary retention 2/2 to anti-cholinergic effects.
Treatment is physostigmine which is an achase inhibitor increasing concentrations of acetylcholine
Describe salicylate intoxication. What’s the treatment?
Salicylate intox: tinnitus, N/V, fever, AMS, metabolic acidosis with resp alkalosis
treatment: sodium bicarb to alkalinize urine
5-HT syndrome symptoms.
tachycardia diaphoresis dilated pupils HTN hyperthermia
What should you suspect in a sickle cell patient with macrocytic anemia?
SCD is usu a chronic normocytic hemolytic anemia with approp reticulocytosis. If pt has macrocytic anemia, suspect a folate deficiency due to increased RBC turnover and increased consumption of folate in the bone marrow. Hence, daily folic acid supplementation is recommended in all SCD pts.
What are the recommendations for colorectal carcinoma screening in someone with ulcerative colitis?
Begin colonoscopy surveillance 8 years after diagnosis. Then repeat every 1-2 years.
Common tetrad describing Parkinson’s
resting tremor (usu starts one-sided)
rigidity
postural instability
bradykinesia
What is hypertensive nephrosclerosis?
pts with chronic HTN and is assoc with retinopathy, LVH, progressive renal failure and mild proteinuria
Paraneoplastic syndromes of SIADH, ACTH and lambert eaton are most commonly assoc with which lung cancer? What about hypercalcemia?
SIADH, ACTH, Lambert –> small cell
hypercalcemia –> squamous
If you suspect adrenal insufficiency (hyponatremia, hyperkalemia, eosinophilia, fatigue, hypotension, hyperpigmentation), what’s the initial step?
-simultaneous basal early morning cortisol, ACTH, and cosyntropin test
low cortisol, high ACTH and minimal response to cosyntropin (ACTH synthetic analogue –> no to little rise in cortisol) –> primary
low cortisol, low ACTH and minimal response to consyntropin (minimal b/c low ACTH has caused adrenal gland atropy–> secondary adrenal insufficiency
lymphocytosis + smudge cells on peripheral blood smear
CLL
presence of thrombocytopenia indicates a poor prognosis
esophageal rupture either via vomiting or from endoscopic procedure can cause pneumomediastinum. Describe.
retrosternal pain
crepitus in suprasternal notch
b/c of esophageal rupture, amylase from saliva will leak into pleural fluid (mostly exudative and low pH)
A painless hard testicular mass + US result showing high likelihood of a testicular tumor, what’s the next step?
no need for biopsy or FNA; go straight to radical orchiectomy
in fact FNA and transcrotal biospy are contraindicated b/c of risk of spillage of cancer cells which can spread thru lymphatics and blood vessels
De Quervain tenosynovitis classically affects? Which 2 tendons are affected?
What’s the finkelstein test?
new mothers who hold their infants with the thumb outstretched (abducted/extended). The abductor pollicis longus and extensor pollicis brevis tendons are affected.
any passive stretch of these tendons elicits pain.
Finkelstein test: passively stretching the affected tendons by grasping the flexed thumb into the palm with fingers elicits pain
What should one suspect in someone with a chronic scar that develops into a nonhealing, painless, bleeding ulcer?
squamous cell carcinoma
Therefore, a punch biospy is warranted
COPD, interstitial lung disease, pulmonary vascular disease and OSA are common etiologies of cor pulmonale. What are some symptoms of cor pulmonale? What do you see on exam and imaging?
symptoms: exertional dyspnea, fatigue, lethargy, exertional syncope (due to decreased CO), exertional angina (due to increased myocardial demand)
PE: peripheral edema, increased JVP w/ a wave, loud S2, right-side heave, pulsatile liver, tricuspid regurg murmur
Imaging:
EKG -right axis deviation, RBBB, RVH
ECHO: pulm HTN, dilated right ventricle, tricuspid regurg
Right heart cath: GOLD STD can show RV dysfunction, pulm HTN without heart disease
someone with metastatic squamous cell carcinoma of the mucosa of the head and neck with a palpable cervical LN. What’s the best initial test?
panendoscopy (triple endoscopy: esophagoscopy, bronchoscopy, laryngoscopy) to detect primary tumor
Compare the coloring of someone who has CO, CN poisoning and methemoglobinia
CO -headache, N/V, vague abd discomfort, confusion, and pinkish-skin hue,
CN-same as CO + almond breath
methemoglobinemia -cyanosis and bluish discoloration
Define Cauda Equina Syndrome in terms of pain, anesthesia, motor weakness, and onset of bowel/bladder dysfunction and either hypo or hyperreflexia
cauda equina (lumbosacral nerves below L1-L2)
Requires emergent MRI, IV glucocorticoids and neurosurg consult
- compression of spinal nerve roots 2/2 to disc herniation or rupture, spinal stenosis, tumors, infection, hemorrhage, iatrogenic
- cauda equina provides sensory innervation to the saddle area
- provides motor to anal and urethral sphincters
- provides parasymp to bladder and lower bowel
sympoms: BILATERAL severe radicular pain, saddle hypo/anesthesia, asymmetric motor weakness, hyporeflexia/areflexia, late-onset bowel and bladder dysfunction
Define Conus Medullaris Syndrome in terms of pain, anesthesia, motor weakness, and onset of bowel/bladder dysfunction and either hypo or hyperreflexia
cauda equina (lumbosacral nerves below L1-L2)
Requires emergent MRI, IV glucocorticoids and neurosurg consult
Conus medullaris is part of the spinal cord so injury here will cause both UMN and LMN signs (vs cauda equina onlyLMN)
- sudden-onset of severe back pain
- perianal hypo/anesthesia
- symmetric motor weakness
- hyperreflexia
- early onset bowel and bladder dysfunction
When should you suspect proteus as the cause of someone’s UTI?
proteus secretes urease that hydrolyzes urea to ammonia and carbon dioxide. ammonia + H+ –> ammonium leading to urinary alkalinization (pH > 7) and promotes formation of struvite stones which will be the nidus for infection.
So suspect proteus in someone with UTI with alkaline urine +/- presence of struvite stones
Of all the therapies available to treat COPD, which has been proven to prolong survival the best?
long-term O2 therapy
use O2 therapy in pts with PaO2 - 55, SaO2 - 88%, and erythrocytosis (hct > 55%) or evid of cor pulmonale
What are some symptoms of acute angle closure glaucoma?
- u/l orbitofrontal headache
- N/V
- u/l severe eye pain with conjunctival injection
- dilated pupil w/ poor light response
w/o treatment can lead to permanent blindness w/in 2-5 hours
Recurrent pneumonia in the same anatomic location is a red flag for bronchial obstruction. If X-ray confirms consolidation, what is your next step in addition to giving abx for the pneumonia?
CT to rule out carcinoma
Bronchoscopy is more invasive and should be done after CT
The anserine bursa is located anteromedially over the tibial plateau just below the joint line of the knee. What are some symptoms of anserine bursitis? How to differentiate from medial collateral ligament damage?
sharply localized pain over the anteromedial part of the tibial plateau. Xrays are normal
not medial collateral ligament damage b/c when you apply valgus stress, it won’t create pain.