Uworld questions Flashcards
Symptoms of digoxin toxicity
cardiac: life-threatening arrhythmias
GI: anorexia, N/V, abdominal pain
neurologic: fatigue, confusion, weakness, color vision alterations
acute toxicity: more GI symptoms
chronic toxicity: more neuro symptoms
Describe the pain found in mesenteric ischemia
severe periumbilical abdominal pain out of proportion to findings on abdominal exam
Risk factors for mesenteric ischemia: AF, severe cardiomyopthy
Parkinson’s tremor (resting tremor that is asymmetric and associated with rigidity) is often the first presenting sign of disease. Which drug is typically used in young parkinsons patients where tremor is the predominant symptom.
trihexyphenidyl (anti-cholinergic agent)
List some clinical features of drug-induced interstitial nephritis (penicillins, cephalosporins and sulfonamides)
- fever, rash, arthralgias, peripheral eosinophilia, hematuria, sterile pyuria, eosinophiluria
- WBC casts may be in urine
- treatment: d/c drug
70% of cases with interstitial nephritis are caused by which drugs
- cephalosporins
- penicillins
- sulfonamides
- sulfonamide containing diuretics
- NSAIDs
- rifampin
- NSAIDs
- phenytoin
- allopurinol
Acute limb ischemia (leg pain, leg is cold with a mottled appearance, minimal swelling w/ absence of distal pulses) from arterial occlusion is typically caused by?
cardiac emboli, thrombosis
Major cardiac sources: LV thrombus, thrombus (usu. left atrial) formation due to AF, aortic atherosclerosis
Management for someone with acute limb ischemia 2/2 to arterial occlusion most likely from cardiac source (symptoms: affected leg is painful, and cold with mottled appearance with little edema)
- immediate anticoagulation
- vascular surgery consultation
- transthoracic ECHO to screen for LV thrombus and evaluate V function
What are clinical symptoms of Vit D toxicity
symptoms are mainly due to hypercalcemia: constipation, abdominal pain, polyuria and polydipsia
State Light’s criteria used in evaluating if effusions are exudative
- pleural fluid protein/serum protein ration > 0.5
- pleural fluid LDH/serum LDH > 0.6
- pleural fluid LDH is > 2/3 the upper limits of normal serum LDH
What conditions cause exudative effusions vs transudative effusions?
-exudative due to increased capillary permeability
infection, autoimmune disease, neoplasm, pulmonary embolism
**if there are lymphocytes in fluid, ddx includes TB, sarcoidosis, lymphoma, RA
-transudative due to decreased plasma oncotic pressure or increased hydrostatic pressure
CHF, liver failure, PE
What’s pathognomonic for Chrohn’s as compared to ulcerative colitis?
non-caseating granulomas but still only present in 60% of the cases
Someone with intention tremors without other neurologic signs that is occasionally relieved by alcohol
essential tremors
- treatment of choice is propranolol
- alternate meds include primidone (can cause acute intermitten porphyia: abd pain, neuro and psych abnormal) and topiramate
Describe the type of population in which IVC filters can be an option for
pts with DVT with contraindications to anticoagulation (recent surgery, hemorrhagic stroke, bleeding diathesis or active bleeding) or recurrent DVTs after treatment with anticoagulation
Describe clinical symptoms and biospy of someone with laxative abuse (aka factitious diarrhea)
- frequent, watery, nocturnal diarrhea
- biopsy will show dark brown discoloration of the colon with lymph follicles shining thru as pale patches (melanosis coli)
acyclovir can cause crystalline nephropathy b/c it is excreted in the urine via glomerular filtration and tubular secretion. How to prevent this?
adequate hydration and dosage adjustment (e.g. slowing rate of IV infusion)
Patellofemoral syndrome typically affects young female athletes who present with subacute to chronic pain that increases with squatting, running, prolonged sitting, climbing stairs.
Explain the patellofemoral compression test and management
pain elicited by extending the knee while compressing the patella
tests such as xray of the knee and MRI are usu normal
management includes exercises to stretch and strengthen the thigh muscles
Which cancer is Eaton-Lambert syndrome associated with? What is it aresult from?
Small cell carcinoma of the lung and results from autoantibodies against voltage-gated calcium channels in presynaptic motor nerve terminal.
Proximal muscle weakness and symptoms improve with muscle use as confirmed by electrophysiological studies (muscle response to motor nerve stimulation should increase with repetitive stimulatiom). Treatment is plasmapheresis and immunosuppressive therapy.
What are some symptoms of hypocalcemia (can occur during or immediately after surgery esp if it requires extensive transfusions since citrate in packed RBCs can bind ionized calcium)?
hyperactive deep tendon reflexes, muscle cramps, convulsions
**symptoms of hypomagesemia can mimic hypocalcemia since Mg2+ is needed for PTH to work
What are signs of mild and severe hypermagnesemia
mild: decreased DTRs
severe: loss of DTRs, muscle paralysis, apnea, cardiac arrest
What is the name of the exam used to assess the eyes after high velocity injuries to look for intraocular foreign bodies and abrasians
fluorescein examination
What’s the agent of choice for malaria ppx in pregnant people and in ppl in areas of chloroquine-resistant p. falciparum
mefloquine
Hemophilia A (Factor VIII def) and B (Factor IX def) both are x-linked presenting with hemarthrosis, hemophilic arthropathy, intramuscular hematomas, GI or GU tract bleeding. Describe lab findings and treatment.
Lab findings: normal platelet count, normal bleeding time, normal prothrombin time, prolonged activated PTT, decreased or absent factor VIII or IX activity
treatment: administer factor VIII or IX
What’s the most reliable and predictive sign in opioid intoxication?
decreased RR
other symptoms: pinpoint pupils although normal pupils can be seen esp in coingestions, hypotension, hypothermia, decreased bowel sounds
Most common cause of Cushing’s? Signs of symptoms of Cushing’s syndrome
iatrogenic steroid administration is the most common cause
signs and symptoms: fatigue, weight gain, easy bruising, central adiposity, proximal muscle weakness, hyperglycemia, osteopenia and osteoporosis, hypertension, acne, cataracts and susceptibility to infections