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A2 > Uworld review 4 > Flashcards

Uworld review 4 Flashcards

1
Q

How can diuretic therapy lead to hepatic encephalopathy exacerbation?

A

Low intravascular volumes with hypokalemia and metabolic alkalosis

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2
Q

How can hypokalemia lead to hepatic encephalopathy?

A

Hypokalemia leads to intracellular acidosis (excreted intracellular K replaced by H+) causes increased NH3 production (E conversion) in the renal tubules

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3
Q

How can metabolic alkalosis exacerbate hepatic encephalopathy?

A

Promotes the conversion of NH4+, which cannot enter the CNS, into NH3, which can

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4
Q

What are the three major steps in treated hepatic encephalopathy?

A
  • Volume resuscitation
  • K replacement
  • Lactulose
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5
Q

Why is proteins restriction not generally indicated for the treatment of hepatic encephalopathy 2/2 liver cirrhosis?

A

Generally, these pts are already malnourished

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6
Q

What is the role of neomycin in the treatment of hepatic encephalopathy?

A

Used when lactulose is not responsive, and cannot tolerate rifaximin

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7
Q

What is rifaximin used for?

A

hepatic encephalopathy

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8
Q

What major heart condition can TB cause?

A

Constrictive pericarditis

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9
Q

What are the s/sx of constrictive pericarditis, and why?

A

Signs of venous overload and decreased CO, since heart cannot fill properly

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10
Q

What is Kussmaul’s sign?

A

Lack of JVP decline with inspiration, which can be seen in pericarditis

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11
Q

What are the characteristic JVP tracings associated with constrictive pericarditis? Why?

A

Prominent X and Y descent

Loss of pressure from stiff pericardial walls during diastole**

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12
Q

What can be heard on cardiac auscultation of cor pulmonale?

A

Widely S2 split with harshed S2

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13
Q

What is the most important initial step in treating HONK? Why?

A
  • Fluid replacement with NS

- Hyperglycemia has a diuretic effect, and can quickly lose fluid

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14
Q

What is the most common cause of a macrocytic anemia in alcoholics?

A

Folate deficiency

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15
Q

What lab abnormalities suggest ITP?

A

Thrombocytopenia, with normal labs otherwise

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16
Q

What is a common cause of ITP?

A

HIV, Hep C, or other chronic viral infx

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17
Q

What is the progression of symptoms with transverse myelitis?

A

Flaccid paralysis (spinal shock), followed by spastic hyperreflexia

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18
Q

What antibody is classically found in systemic sclerosis?

A

Anti-topoisomerase 1 (aka anti-scl-70)

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19
Q

What causes HTN with systemic sclerosis?

A

Renal involvement

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20
Q

What antibodies are found with antiphospholipid antibody syndrome?

A

Anti cardiolipin

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21
Q

Antimitochondrial antibodies are found in which disease?

A

Primary biliary cholangitis

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22
Q

What is granulomatosis with polyangiitis? What antibody is classic for this?

A

Wegener’s granulomatosis

ANti-neutrophil cytoplasmic antibodies

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23
Q

What is the key test to diagnosing bronchiectasis? What will it show?

A

High res CT

Bronchial wall thickening

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24
Q

What is the pathophysiology of bronchiectasis?

A

Recurrent cycle of infection, inflammation, and tissue damage

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25
Q

What are the classic symptoms of bronchiectasis?

A

Large amounts of purulent sputum
Dyspnea
sinus congestion
Hemoptysis

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26
Q

What parts of the body does Kaposi’s sarcoma classically present on?

A

Face
Legs
Oral cavity
Genitalia

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27
Q

What are the lesions of bacillary angiomatosis like?

A

Friable papules and plaques

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28
Q

What are the skin lesions of cryptococcosis like?

A

Multiple papules diffusely

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29
Q

What is the classic presentation of parvovirus B19 arthralgias?

A

Symmetric, polyarticular arthralgias, without overlying erythema, edema, or systemic symptoms.

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30
Q

True or false: in both SLE and RA, symptoms correspond to inflammatory markers like ESR

A

True

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31
Q

Crypt abscesses are classically found in which IBD?

A

UC

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32
Q

Pts with ulcerative colitis are at increased risk for developing which biliary issue?

A

Primary sclerosing cholangitis

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33
Q

An elevated serum alk phos in a pt with UC should be suspicious for what disease?

A

Primary sclerosing cholangitis

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34
Q

What cells comprise a pheochromocytoma?

A

Chromaffin cells

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35
Q

What drugs in particular can set off a hypertensive episode 2/2 pheochromocytoma?

A

Anesthetic agents

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36
Q

What is the first test in the workup of AKI in the setting of BPH?

A

US of the kidneys to r/o obstruction or other causes of hydronephrosis

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37
Q

What is a hepatic hydrothorax?

A

Pleural effusion that occurs from small defects in the diaphragm, that allow peritoneal fluid to pass into the pleural space. This is more common on the right side due to the less muscular hemidiaphragm

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38
Q

What is hepatopulmonary syndrome?

A

Hepatopulmonary syndrome results from the formation of microscopic intrapulmonary arteriovenous dilatations in patients with both chronic and far less common, acute liver failure. The mechanism is unknown but is thought to be due to increased liver production or decreased liver clearance of vasodilators, possibly involving nitric oxide.

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39
Q

What are the two classic symptoms of hepatopulmonary syndrome?

A

Platypnea (dyspnea while upright)

Orthodeoxia (O2 desat when upright)

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40
Q

Why should atropine be avoided in pts with acute angle closure glaucoma?

A

dilates the eye, worsening outflow obstruction

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41
Q

What is the MOA and use of pilocarpine?

A

Cholinergic agent used for acute angle closure glaucoma

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42
Q

What is the difference between herpes zoster ophthalmicus and herpes simplex keratitis?

A

Zoster will have shingles around the eye, whilst simplex with only involve the eye, without systemic s/sx

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43
Q

Under what CD4 count does PCP occur?

A

200

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44
Q

What are the indications for the use of steroids in addition to bactrim in the treatment of PCP pneumonia?

A
  • Severe s/sx
  • PaO2 less than 70 mmHg
  • A-a gradient over 35 mmHg
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45
Q

What is the treatment for neurosyphilis?

A

10-14 days of IV PCN

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46
Q

What are the s/sx of spinal cord compression?

A
  • Pain worse in the recumbent position
  • Gradually worsening, severe local back pain
  • Sudden weakness and anesthesia below level of lesion
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47
Q

What is the management of spinal cord compression?

A
  • MRI
  • Corticosteroids
  • Rad-onc and neurosurgery consult
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48
Q

A sensory level at what anatomic landmark exclude cauda equina syndrome?

A

Umbilicus (T10)

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49
Q

what are the classic findings on XR of Charcot’s foot?

A
  • effusions in several of the tarsometatarsal jts
  • large osteophytes
  • extra-articular bone fragments
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50
Q

How does primary sclerosing cholangitis commonly present?

A
  • asymptomatic

- cholestatic pattern on liver test

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51
Q

What is the gross description of primary sclerosing cholangitis?

A

Short annular strictures alternating with normal bile duct

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52
Q

What happens to cardiac index and PCWP with a tension pneumothorax?

A

CI: low

PCWP: low

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53
Q

What happens to cardiac index and PCWP with a PE

A

CI: low
PCWP: normal to low

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54
Q

What are the s/sx of osteonecrosis of the proximal femur?

A

Hip pain

Limited internal rotation and abduction

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55
Q

How does sickle cell disease lead to osteonecrosis of the femur?

A

Disruption of microcirculation in the bone by sickling as well as increased intraosseous pressure d/t bone marrow hyperplasia

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56
Q

Why is the risk of femoral head necrosis increased later in life?

A

Initially, blood supply from ascending arteries and foveal artery. Foveal becomes obliterated later in life.

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57
Q

What labs are classically elevated in osteomyelitis? signs?

A

ESR

Typical infx symptoms

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58
Q

What happens to thyroglobulin levels with exogenous levothyroxine intake?

A

Decreased

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59
Q

What are the s/sx of subacute (de quervain’s) thyroiditis?

A

Fever
Neck pain
Thyroid TTP
Elevated ESR

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60
Q

What are the s/sx of Hashimoto’s thyroiditis?

A

Palpable goiter and clinical hypothyroidism.

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61
Q

What skin condition can manifest in pts with chronic Hep C infection?

A

Porphyria cutanea tarda

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62
Q

What are the s/sx of Takayasu arteritis?

A

Vasculitis of the aorta and its branches, with arterial occlusive s/sx, including pulse deficits, bruits, BP discrepancies

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63
Q

In whom is Takayasu’s arteritis most common in?

A

Asian Women under 40

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64
Q

What are the lab findings of Takayasu’s arteritis?

A

Elevated ESR and CRP

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65
Q

What is the treatment for Takayasu’s arteritis?

A

Steroids

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66
Q

What can imaging find with Takayasu’s arteritis?

A

Thickening of large artery walls and narrowing lumen

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67
Q

What abx should be prescribed prophylactically to solid organ transplant recipients? Why?

A

TMP-SMX (PCP)

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68
Q

What type of nerves cause the s/sx of peripheral neuropathy in DM?

A
  • Small nerve fiber injury causes positive symptoms (tingling, allodynia, pain)
  • Large fiber injury causes negative symptoms (numbness, loss of proprioception, diminished ankle reflex)
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69
Q

What are the symptoms of Cardiac myxoma?

A

Fever, weight loss, raynaud’s

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70
Q

What heart sound does myxomatous degeneration of the mitral valve cause?

A

Midsystolic click

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71
Q

What are the most common benign primary tumors of the heart? What sound does it cause?

A

Myxomas

Tumor plop

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72
Q

What are the complications of Cardiac myxomas?

A
  • Embolization
  • Valvular abnormalities
  • HF 2/2 obstruction
  • Lung invasion causes symptoms similar to bronchogenic CA
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73
Q

What is alanine converted into top enter the kreb’s cycle?

A

Pyruvate

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74
Q

What is lactate converted into top enter the Kreb’s cycle?

A

Pyruvate

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75
Q

What are triacylglycerols converted into to enter the Kreb’s cycle?

A

G3P

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76
Q

What is the treatment for gastroparesis 2/2 DM?

A

Metoclopramide or erythromycin

Small, frequent meals

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77
Q

Which promotility/antiemetic agent is associated with EPS?

A

Metoclopramide

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78
Q

What are the s/sx of gastroparesis 2/2 DM? (4)

A

ANorexia
n/v
Early satiety
Impaired glycemic control

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79
Q

Stroke symptoms that are abrupt and maximal at the start is generally of what etiology?

A

Embolic stroke

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80
Q

Stroke symptoms that fluctuate are generally of what etiology?

A

Thrombosis

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81
Q

Stroke symptoms that progress over minutes to hours, with early onset focal neurologic deficits, and later on s/sx of increased ICP are generally of what etiology?

A

Intracerebral hemorrhage

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82
Q

What are the s/sx of a spontaneous subarachnoid hemorrhage? (3)

A
  • Severe HA at start
  • Meningeal irritation
  • Focal deficits uncommon
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83
Q

What are the characteristics of the HA with idiopathic intracranial HTN?

A

Pulsatile HA with pulsatile tinnitus

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84
Q

What medication classically causes idiopathic intracranial HTN?

A

Isotretinoin

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85
Q

What are the 6 classic s/sx of idiopathic intracranial HTN?

A
  • Papilledema
  • Peripheral visual defect
  • CN VI palsy
  • HA
  • Pulsatile tinnitus
  • Diplopia
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86
Q

What type of studies produce relative risk ratios?

A

Cohort studies

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87
Q

What type of studies produce Odds ratio?

A

Case-control

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88
Q

If a disease is rare, what can be said about RR and OR?

A

nearly equivalent

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89
Q

What are the common s/sx of Waldenstrom’s macroglobulinemia?

A

Hyperviscosity syndrome

HSM

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90
Q

What is the difference between multiple myeloma and Waldenstrom’s macroglobulinemia?

A

MM has “multiple” types of immunoglobin expansion, whereas WM has only IgM

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91
Q

What will bone marrow bx show in multiple myeloma vs Waldenstrom’s macroglobulinemia?

A

Both have over 10% monoclonal B cells

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92
Q

What is the process of diagnosing Hep C? Why?

A

HCV antibody and HCV DNA. Need DNA to assess whether the pt cleared it spontaneously, or is chronically infected

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93
Q

What causes hyponatremia in severe decompensated HF?

A

Decreased perfusions at baroreceptors and renal afferent arterioles causes release of Renin, NE, and ADH. All of these promote free water retention

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94
Q

Describe the difference in eye involvement between viral, bacterial, and allergic conjunctivitis.

A
  • Viral-unilateral that progresses to bilateral
  • Bacterial- “ “
  • Allergic - bilateral
95
Q

Which has a characteristic “eye stuck shut” in the morning symptom: viral, bacterial, and/or allergic conjunctivitis

96
Q

Describe the discharge present with viral, bacterial, and allergic conjunctivitis

A 
Viral = watery with scant, stringy mucus
Bacterial = pus
Allergic = water
97
Q

Which type of conjunctivitis has discharge the reappears after wiping: viral, bacterial, and/or allergic

98
Q

True or false: discharge is common with anterior uveitis

99
Q

What are the s/sx of anterior uveitis?

A

Pain
Photophobia
Miosis
Visual loss

100
Q

What is the most significant risk factor for ischemic and hemorrhagic stroke?

A

HTN for both

101
Q

What sort of neurological symptoms are present in Guillain Barre syndrome? (LMN vs UMN, sensation)

A
  • LMN
  • Weakness
  • NO sensory loss
102
Q

What is the major downside to using chem to treat Hodgkin’s lymphoma?

A

18.5x risk for other malignancies

103
Q

What are the CXR findings of an aspergilloma?

A

Mobile, intracavitary mass with an Air Crescent in the periphery

104
Q

What is the treatment for actinomyces?

105
Q

What is the classic presentation of an actinomyces infection?

A 
Invasive disease (dental, sinus) in pts with DM
*Sinus tracts with sulfur granules*
106
Q

What are the microscopic characteristics of actinomyces?

A

Filamentous Gram positive rods with rudimentary branching

107
Q

Why are pts with Crohn’s disease at increased risk of developing Calcium oxalate stones?

A

In pts with fat malabsorption, Ca is preferentially bound by fat, leaving oxalate unbound and free to be absorbed into the bloodstream.

108
Q

What are the manifestations of CN toxicity?

A

Cherry red flushing
AMS / seizures / hyperreflexia
Arrhythmias
Metabolic acidosis

109
Q

What is a steppage gait, and what causes it?

A

Weakness in foot dorsiflexion, causing a compensation of high steppage

110
Q

What are the skin lesions like with urticaria?

A

well circumscribed, raised erythematous plaques with central pallor.

These can be round, oval, or serpiginous, and up to several centimeters in diameter

111
Q

Within how many hours of symptom onset can tPA be administered?

A

3.5-4 hours

112
Q

What is the only therapy that reduces the risk of early recurrent ischemic stroke?

113
Q

What is the classic triad for a splenic abscess?

A

Fever
Leukocytosis
LUQ pain / pleuritic left sided chest pain

114
Q

What will CT imaging show with a splenic abscess?

A

Splenic fluid collection

115
Q

What is a major predisposing factor for the development of a splenic abscess?

A

Infective endocarditis

116
Q

What bacteria commonly cause a splenic abscess? (3)

A

Staph aureus
Strep
Salmonella

117
Q

What is and what is not the treatment for a splenic abscess?

A

Surgery

Abx alone is not sufficient

118
Q

What is the general pathophysiology of Paget’s disease?

A

Increased bone turnover 2/2 osteoclast dysfunction

119
Q

What is the classic histologic appearance of Paget’s disease?

A

Mosaic pattern of lamellar bone

120
Q

What are the three major cardiac findings of aortic stenosis?

A
  1. Systolic ejection murmur
  2. Single and soft S2
  3. Delayed and diminished carotid pulse (pulsus parvus et tardus)
121
Q

What is pulsus paradoxus, and what it is classically seen in?

A

Exaggerated decrease (more than 10 mmHg) in SBP with inspiration

Pericardial disease (e.g. tamponade)

122
Q

What is the definition of reversibility of asthma?

A

Increase of FEV1 over 12% post bronchodilator

123
Q

How much protein is excreted per day in nephrotic syndrome?

A

More than 3.5 g/day

124
Q

What are the associations with focal segmental glomerulosclerosis?

A

HIV
Heroin use
AA or hispanic ethnicity
Obesity

125
Q

What are the associations with membranous nephropathy?

A

Adenocarcinoma
NSAID use
Hep B
SLE

126
Q

What are the associations with membranoproliferative glomerulonephritis?

A

Hep B and C

Lymphoma

127
Q

What are the associations with minimal change disease?

A

NSAIDs

Lymphoma

128
Q

What are the s/sx of porphyria cutanea tarda?

A

Photosensitivity blisters that are pruritic, healing with scarring, increased skin fragility, hypertrichosis, and hyperpigmentation

129
Q

What is the effect of OCPs on PCT?

A

Triggers it

130
Q

What is Behcet’s disease?

A

Rare, immune mediated small vessel systemic vasculitis that often presents with membrane ulceration (e.g. mouth, genitals) and ocular problems (anterior/posterior uveitis, retinal vasculitis)

131
Q

What is Felty syndrome?

A

Advanced RA associated with splenomegaly and neutropenia

132
Q

What are the classic s/sx of a vertebral compression fracture?

A
  • Acute back pain after physical activity
  • Pt TTP along the spine
  • Worse with increased intraabdominal pressure, standing, walking, or lying on the back
133
Q

What is the most common underlying cause of a non-traumatic vertebral compression fracture?

A

Osteoporosis

134
Q

What relieves and exacerbates the pain of a ligamentous back sprain?

A

Worse with movement, and improves with rest

135
Q

What is the drug of choice for treating pseudotumor cerebri? Why?

A

Acetazolamide

Inhibits choroid plexus CAH, thereby decreasing CSF production, and IH

136
Q

Which CN can be affected with idiopathic intracranial HTN?

137
Q

What is the role of theophylline in the treatment of acute asthma exacerbations?

138
Q

When is it okay to accept gifts from drug reps?

A
  • Directly benefits patients

- Of small value

139
Q

What are a few of the differences between how allergic vs irritant contact dermatitis looks?

A

Allergic has papules and vesicles, and chronic lichenification

Irritant has fissures and erythema. Most commonly on hands

140
Q

What is a common side effect of EPO?

A

Worsening HTN

141
Q

How may renal stones cause an ileus?

A

Increased vagal tone

142
Q

What cancer needs to be looked out for if a pt has a h/o pernicious anemia?

A

Gastric cancer, since atrophic gastritis that develops increase risk for intestinal type cancer

143
Q

What is the MOA and use of eplerenone?

A

Aldosterone receptor antagonist

144
Q

What is a major difference between eplerenone and spironolactone?

A

Spironolactone has anti androgen effects, while eplerenone does not

145
Q

What is the drug of choice for treating hyperaldosteronism in a male?

A

Eplerenone

146
Q

When is an abdominal CT scan indicated for the diagnosis of pyelonephritis? Why?

A
  • If no improvement in 72 hours

- Complicated pyelo may lead to corticomedullary abscess, emphysematous pyelo, or papillary necrosis

147
Q

What is the cause of hypercalcemia d/t immobilization?

A

Increased osteoclast bone resorption

148
Q

What is the treatment for hypercalcemia of malignancy? Of immobilization?

A

Bisphosphonates

149
Q

What is the general MOA of bisphosphonates?

A

Inhibit osteoclast bone resorption

150
Q

What is the effect on Ca levels in rhabdo?

A

hypocalcemia 2/2 precipitation of Ca and phosphorus in damaged muscles

151
Q

What are the cardiac effects of sarcoidosis? (4)

A

Can cause AV block
Restrictive cardiomyopathy
Dilated cardiomyopathy
HF

152
Q

What are the s/sx of disseminated gonococcal infex?

A

Fever
Polyarthralgia (e.g. ankle and wrist)
Pustular rash over extremities and torso

153
Q

How do you diagnose disseminated gonococcal infex?

A

NAAT, as cultures are frequently negative

154
Q

What is the age range for mammography?

155
Q

How often are lipid panels checked for routine preventative care in pts without a history of hyperlipidemia?

156
Q

What is the age range for colonoscopy?

157
Q

Why are patients with RA more likely to develop osteoporosis?

A
  • Decreased activity levels

- local inflammation and proinflammatory cytokines around joints

158
Q

What are the risk factors for avascular necrosis? (4)

A
  • Prolonged corticosteroid use
  • EtOH use
  • SLE
  • Sickle cell
159
Q

What is osteitis fibrosa cystica?

A

Excessive osteoclastic resorption of bone, leading to replacement with fibrous tissue (brown tumors)

160
Q

What are the hematologic effects of EBV? MOA?

A

Hemolytic anemia and thrombocytopenia

Cross reactivity of antibodies against EBV to RBCs, causing Cold agglutinins

161
Q

What is the drug of choice to prevent cerebral vasospasm s/p coiling of ruptured cerebral vessels?

A

nimodipine

162
Q

What is the most common cause of death s/p coiling for SAH?

163
Q

What is the treatment for polymyalgia rheumatica?

A

Low dose corticosteroids

164
Q

Why are right sided MIs preload dependent?

A

MI impairs RV filling, causing an increased sensitivity to decreased preload, as the ventricle cannot relax properly (relaxation is ATP driven), and need volume to stretch

165
Q

What is the first step in treating cardiogenic shock 2/2 right sided MI? Second?

A

IV fluid bolus is first, then dopamine if they’re crashing

166
Q

What is the effect of Na intake on the formation of Ca stones?

A

Increased Na intake enhances Ca excretion, and low Na intake promotes Na and Ca absorption

167
Q

What is the treatment for vitiligo?

A

Topical corticosteroids

168
Q

Congenital patchy absence of melanocytes is characteristic of what disease?

A

Piebaldism

169
Q

What is the treatment for severe causes of fulminant hepatic failure 2/2 acetaminophen poisoning?

A

Transfer for liver transplant

170
Q

What type of EKG findings are diagnostic for V-tach?

A

fusion beats

171
Q

What causes dupuytren’s contracture in liver cirrhosis?

A

Increased free ROS

172
Q

Pure motor hemiparesis is classically associated with a stroke to what part of the brain?

173
Q

Pure sensory loss is classically associated with a stroke to what part of the brain?

174
Q

Dysarthria-clumsy hand is classically associated with a stroke to what part of the brain?

175
Q

Ataxis hemiparesis is classically associated with a stroke to what part of the brain?

176
Q

What are the presenting symptoms of a middle cerebral artery stroke?

A

Contralateral motor and/or somatosensory deficits, and homonymous hemianopia or quadrantanopia

177
Q

What are the s/sx of occlusion of an internal carotid artery?

A

Both MCA and ACA territories affected

178
Q

What are the neurologic deficits from a posterior cerebral artery stroke?

A 
Homonoymous hemianopia
Alexia without agraphia
visual hamllucinations (calcarine cortex)
Sensory symptoms (thalamus)
3rd nerve pasly
contralateral motor deficits
179
Q

What part of the brain is affected in a PCA stroke, that causes visual hallucinations?

A

Calcarine cortex

180
Q

What part of the brain is affected in a PCA stroke, that causes sensory symptoms?

181
Q

What part of the brain is affected in a PCA stroke, that causes contralateral motor deficits?

A

Cerebral peduncle, midbrain

182
Q

What are the major risk factors for acalculous cholecystitis? Why?

A
  • Severe trauma or recent surgery
  • Prolonged TPN
  • Critical illness

These likely cause gallbladder stasis or ischemia with local inflammation that can lead to gallbladder distension

183
Q

What are the labs like with acalculous cholecystitis?

A

Normal to elevated

184
Q

What are the s/sx of acalculous cholecystitis?

A

Unexplained fever
RUQ pain
Leukocytosis

185
Q

What usually causes a subphrenic abscess?

A

peritonitis

186
Q

What is a hazard ratio, and how do you interpret it?

A

The chance of an event occurring in the treatment group compared to the chanced of that event occurring in the control group during a set period

If HR is less than 1, the event is more likely to occur in the control group

If HR more than 1, the event is more likely to occur in the experimental group

If = 1, then no difference

187
Q

What is the most common pathophysiologic cause of atrial flutter?

A

Reentrant circuit around the tricuspid annulus, with slowing of the impulse through a region known as the cavotricuspid isthmus

188
Q

What location is the most common source of ectopic electrical activity to produce atrial fibrillation?

A

Pulmonary veins

189
Q

When is rabies PEP needed?

A

If exposed to high risk animal, or animal unavailable to watch.

190
Q

What is the classic presentation of ankylosing spondylitis?

A

Chronic, progressive back pain and stiffness.
Pain relief with activity
Lumbosacral tenderness

191
Q

How do you confirm the diagnosis of ankylosing spondylitis?

A

x-rays of the pelvis showing sacroiliitis

192
Q

What is the role of the HLA-B27 haplotype in diagnosing ankylosing spondylitis?

A

No much, since most people who have the gene, do not get ankylosing spondylitis

193
Q

What is the classic description of the vision loss with amaurosis fugax (

A

Curtain veil descending over the visual field

194
Q

What is the most common site of artherosclerosic emboli that cause rentinal artery occlusion?

195
Q

When is carotid endarterectomy indicated for symptomatic and asymptomatic men respectively? Women?

A

Asymptomatic men = 60+%
Symptomatic men = 50+%
Women = 70%+

196
Q

What are the s/sx of vertebral osteomyelitis?

A

Exquisite focal tenderness

ESP and CRP elevated

197
Q

Tight glycemic control for DM has benefits for what type of vascular problems?

A

Microvascular (eyes, nephropathy) NOT macrovascular (MI, stroke)

198
Q

What is the abx of choice for HACEK group of organisms causing endocarditis?

A

Ampicillin-sulbactam (unasyn)

199
Q

Native valve endocarditis caused by strep viridans group should receive what abx?

A

Aqueous PCN G

200
Q

How is hereditary spherocytosis treated? Why?

A

Splenectomy since RBC function fine, but spleen crushes them

201
Q

What are the three most common causes of bloody diarrhea?

A
  • E.coli
  • Shigella
  • Campylobacter
202
Q

What is the MOA and use of doxazosin?

A

Alpha receptor blocker, BPH

203
Q

How does a bluish tint to the vision occur with PDE-5 inhibitors?

A

Cross reactivity with PDE-6 involved in color vision

204
Q

What effect does uremia have on anion gap?

A

Causes an anion gap metabolic acidosis

205
Q

What are the compensations to chronically higher levels of CO2 in the blood from COPD?

A

Increased bicarb

206
Q

What is the calculation for NNT?

207
Q

Will E.coli produce nitrites?

208
Q

What are the characteristics of BCC? (5)

A
  • Persistent open sore that bleeds, oozes, or crusts
  • Reddish patch or irritated area
  • Pearly or translucent nodule that is pink, red, or white
  • ELevated or rolled border with central ulceration
  • Pale, scar-like area with poorly defined borders
209
Q

What are the characteristics of a keratoacanthoma?

A

Volcano like nodule with central keratotic plug

210
Q

What are the characteristics of rosacea?

A

Flushing, erythema, telangiectasias, papules/pustules and tissue hyperplasia

211
Q

What part of the spine is affected with ankylosing spondylitis that causes the pain?

A

Ligamentous insertions (enthesitis)

212
Q

Are follicular thyroid CA usually hot or cold?

213
Q

How does follicular thyroid CA differ from benign follicular adenomas?

A

Grow through capsule, and spread hematogenously

214
Q

How does follicular thyroid CA spread?

A

Hematogenously

215
Q

What sort of thyroid cancer has psammoma bodies?

216
Q

Hurthle cells are seen in which Thyroid CA?

A

Hashimoto’s

217
Q

How can you differentiate malpositioning of an ET tube vs tension pneumothorax?

A

Tension pneumothorax will have hemodynamic compromise

218
Q

What test can be used to confirm the diagnosis of carpal tunnel syndrome?

A

Nerve conduction studies

219
Q

What tendons are contained within the carpal tunnel?

A

Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus

220
Q

Which is more common on the lower lip: basal cell carcinoma, or SCC?

221
Q

What are the histological findings of SCC?

A

Invasive squamous cells with keratin pearls

222
Q

What is the relation between breast tenderness and OCPs?

A

Increases initially with OCP use, but subsides. Shouldn’t have an effect coming off of the meds.

223
Q

Breast pain the occurs coming off of OCPs is most likely what?

A

Fibrocystic changes

224
Q

What is the treatment for breast tenderness 2/2 fibrocystic changes?

A

NSAIDs or OCPs

225
Q

What are the signs of cerebral salt wasting?

A

Hypovolemia and hyponatremia with a high urine sodium

226
Q

What causes cerebral salt wasting?

A

Decreased SNS input to kidneys decrease the salt retention

227
Q

What are the causes of hyponatremia in the setting of elevated urine Na? (4)

A
  • Diuretic use
  • Cerebral salt wasting syndrome
  • Adrenal insufficiency
  • AKI/CKD
228
Q

What are the classic EKG findings of cor pulmonale?

A

RBBB with RAD and/or RVH, RAA

229
Q

CXR showing enlarged pulmonary arteries is classic for what condition?

A

Cor pulmonale

230
Q

What is multiple system atrophy (shy-drager syndrome)?

A

Degenerative disease causing

  • parkinsonism
  • Autonomic dysfunction (orthostatic hypotension)
  • Widespread neurologic signs
231
Q

Pt with parkinsonian symptoms + orthostatic hypotension + impotence/incontinence = ?

A

Multiple system atrophy

232
Q

What parts of the brain are affected with multiple system atrophy? (4)

A

Neuronal degeneration in the substantia nigra, striatum, ANS and cerebellum

233
Q

What are the histologic hallmarks of multiple system atrophy?

A

Cell loss and gliosis, or a proliferation of astrocytes

234
Q

What is Riley-Day syndrome (familial dysautonomia)? (cause, pathophys/symptoms) Does this affect intelligence?

A

AR disease on chromosome 9, affecting the development and survival of sensory, sympathetic, and some PNS neurons.

This results in insensitivity to pain, inability to produce tears, poor growth, and labile BPs.

Does not affect intelligence

A2 (26 decks)

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