Uworld Review Flashcards
1
Q
What will an SPEP show with multiple myeloma?
A
M-spike
2
Q
What bone marrow bx finding is diagnostic of multiple myeloma?
A
More than 10% clonal plasma cells
3
Q
What are the bone marrow bx findings of aplastic anemia?
A
Hypoplastic fat-filled marrow
4
Q
What are the six steps of asthma pharmacotherapy (increasing in severity)?
A
- SABA only
- SABA + low dose ICS
- LABA + low dose ICS
- LABA and medium dose ICS
- High dose ICS + LABA
- High dose ICS + LABA + oral corticosteroid
5
Q
How many nighttime awakenings and daytime symptoms classify mild, intermittent asthma?
A
Less than 2 /day and 2 nights / month
6
Q
What are the classic EEG findings of prion diseases?
A
Intermittent sharp waves
7
Q
What are the classic s/sx of prion disease?
A
Rapidly progressing dementia with myoclonus
8
Q
What is malignant otitis externa, and what is the treatment (drug and route)?
A
Severe infection of the external auditory canal, caused by pseudomonas.
IV ciprofloxacin
9
Q
What is the pathophysiology of pemphigus vulgaris and bullous pemphigoid?
A
Pemphigus vulgaris = abs against hemidesmosomes
BUllous pemphigoid = abs against desmosomes
10
Q
What is the treatment for refractory ITP?
A
Splenectomy
11
Q
When is IVIG indicated for the treatment of ITP?
A
Newly diagnosed with severe bleeding
12
Q
What is the goal platelet count when treating ITP?
A
over 30,000
13
Q
What is the MOA and route of Liraglutide?
A
Injectable GLP-1 agonist
14
Q
What is the MOA and route of sitagliptin?
A
DPP-4 inhibitor
15
Q
What drugs should be acoided in pts with a h/o intracranial hemorrhage?
A
Nitrates because may increased ICP and risk another rupture
16
Q
What are the CSF findings of Guillain-barre syndrome? What is the term for this/what does it mean?
A
Elevation in CSF proteins, without elevation in WBC count
17
Q
What are the two major side effects of cimetidine?
A
Pancytopenia and renal failure
18
Q
When does autism screening begin?
A
at 18 months and 2 years
19
Q
How many wet diapers a day is common in a neonate? Stools?
A
8 wet diapers
2 stools
20
Q
Under what age should a child never receive straight cow’s milk? Why?
A
- Under 12 months
- Infants do not tolerate the protein mixture of unaltered cow’s milk and may develop colitis, causing microscopic bleeding and gradually worsening anemia.
21
Q
Most babies lose a little weight right after birth, then may regain their birth weight as early as 1 week of age, but are definitely expected to have regained their birth weight by when?
A
2 weeks
22
Q
What type of testicular cancer produces beta hCG?
A
Seminomas and choriocarcinomas
23
Q
What type of testicular cancers produce afp?
A
Choriocarcinomas
embryonal cell carcinomas
24
Q
What type of testicular cancers produces LDH?
A
Seminomas
25
Prolongation of life in pts with CHF has been documented with which 5 medications?
```
ACEIs
ARBs
Beta blockers
Aldosterone antagonists (spironolactone)
Hydralazine + nitrate
```
26
Strokes to the left superior middle cerebral artery lead to what language problems?
Brocas
27
Strokes to the left inferior middle cerebral artery lead to what language problems?
Wernicke's
28
What happens to renin activity with diuretic use?
Increased since the kidney is seeing too much volume being wasted
29
What is the aldosterone escape seen in Conn syndrome?
Aldosterone initially induces sodium and water retention; this is followed within a few days by a spontaneous diuresis, which returns excretion to the level of intake and partially lowers the extracellular fluid volume toward normal.
30
What is the effect of beta blockers on bg levels?
Decreases, since blocks the breakdown of glycogen to glucose
31
Squamous cell bladder cancer in an immigrant means infection with what?
Schistosoma haematobium
32
What is the treatment for schistosoma?
Praziquantel and prednisone
33
Why is there pain at the end of urination with a schistosoma infection?
Extrusion of eggs
34
What is the PaO2 / FiO2 ratio for ards?
Less than or equal to 300
35
What are light's criteria for diagnosing an exudative pleural effusion?
1. if pleural fluid protein / serum protein is over 0.5
2. If pleural LDH / serum LDH is over 0.6
3. if pleural LDH is over 2/3 normal
36
What is the imaging test of choice to diagnose an aortic dissection in a hemodynamically unstable pt?
US
37
What is the treatment for symptomatic coccidioidomycosis localized to the lungs in an immunocompromised pt?
Oral fluconazole x 12 months
38
Which s/sx of Grave's disease is not usually seen in young pts?
Pretibial myxedema
39
What is the recommended screening test for adrenal insufficiency?
Cosyntropin stimulation test
40
What is the first step in treatment of acute lung rejection after stabilization?
Bx of the bronchi to r/o CMV and/or other infectious causes of lung disease
41
What is the order of drugs that should be tried with symptomatic bradycardia?
```
Atropine
Transcutaneous pacing
Dopamine
Epi
Isoproterenol
```
("All Trained Dogs Eat Iams")
42
What drug should be avoided in pts with an inferior MI (RV)?
Nitro
43
What are the antibodies associated with primary biliary cirrhosis?
Antimitochondrial antibodies
44
What are the antibodies associated with autoimmune hepatitis?
Antismooth muscle antibodies
45
What are the antibodies associated with primary sclerosing cholangitis?
p-ANCA
46
With what comorbidities is indomethacin contraindicated for the treatment of an acute gout flare?What is used instead?
Renal failure of GI bleeds
| Colchicine
47
What electrolyte abnormality is common with Amp B useage?
Hypokalemia (type I RTA)
48
How many weeks post tick bite are ELISA testing unreliable for Lyme disease?
2 weeks or less
49
What is the first line agent for treating cardiogenic shock in the setting of an acute MI?
Norepi
50
What is the metyrapone stimulation test?
Metyrapone blocks the last step in the synthesis of cortisol at the level of the adrenal gland, and induces a rapid fall of serum levels, which normally leads to increases in ACTH secretion. In pts with tertiary AI, metyrapone stimulation fails to produce a rise in ACTH levels
51
What is the most sensitive radiographic sign of hyperparathyroidism?
Subperiosteal bone resorption of the phalanges
52
What is the difference between hyperparathyroidism 2/2 primary disease vs renal disease in terms of phosphate levels?
Primary = depressed
| Renal disease = elevated
53
What is the treatment for IgA nephropathy?
ACEIs
54
What is the treatment for Goodpasture syndrome?
Plasmapheresis to reduce abs
55
What are the muscle bx findings of inclusion body myositis?
beta-amyloid deposits
56
What is always true in polymyositis that is not always true of dermatomyositis and inclusion body myositis?
CK is elevated in polymyositis
57
What is the drug of choice in treating cysteine renal stones?
Penicillamine
58
What are the amino acids that cannot be reabsorbed in cystinuria?
Cystine
Ornithine
Arginine
Lysine
59
What is the prophylactic treatment for preventing uric acid renal stones?
Allopurinol
60
What is the immunostaining pattern on renal bx associated with Alport syndrome?
Basketweave appearance (splitting of the lamina densa of the glomerular BM)
61
What is the inheritance pattern of Alport syndrome?
XLR
62
What is the classic triad of symptoms of Alport syndrome?
Sensorineural hearing loss
Nephritis
anterior lenticonus
63
What type of diuretics can increase the chances of uric acid stones?
Loop
64
What is the treatment for disseminated cryptococcus neoformans?
Amp B + 5FU
65
How often should pts with UC have a colonoscopy?
1-3 years
66
What is the marker for following recurrence of: colon cancer
CEA
67
What is the marker for following recurrence of: hepatocellular carcinoma
alpha-fetoprotein
68
What is the marker for following recurrence of: Ovarian cancer?
CA-125
69
What is the marker for following recurrence of: hCG
Gestational trophoblast disease and germ cell tumors
70
What is the drug for prophylaxis of cystinuria? MOA? Side effect?
potassium bicarb--alkalinization of the urine increases solubility of cystine
This, however, increases the risk for Ca stones
71
What comorbid condition may increase the likelihood of lactic acidosis in a pt taking metformin?
HF
72
What comorbidity increases the disease severity of RA?
Smoking
73
What is the amount of protein lost in the urine with nephrotic syndromes?
over 3 g / day
74
Loss of protein S and C with nephrotic syndrome leads to what hemodynamic change?
Hypercoagulability
75
What is the classic side effect of ethambutol?
Optic neuritis
76
What is the classic pentad of TTP?
- hemolytic anemia
- thrombocytopenic purpura
- neurological abnormalities
- Fever
- renal disease
77
What hemodynamic changes occur with OSA?
During apneic episodes, increased negative internal thoracic pressure increases LV afterload, and adversely affecting LV function
78
What are the two labs that are elevated with diamond blackfan anemia?
Hb F
| Erythrocyte adenosine deaminase (eADA)
79
What is the inheritance pattern of diamond blackfan anemia?
AD
80
What type of anemia is Diamond blackfan anemia (macro/normo/microcytic)
Normocytic to macrocytic
81
What is the drug of choice for postsplenectomy sepsis?
Levaquin
82
What is the indication for a splenectomy in a pt with ITP?
Failure with medical therapy for 6 weeks
83
What are the histological characteristics of mycosis fungoides?
Clusters of atypical lymphocytes (pautrier's abscesses) aligned along the basal layer and epidermal microabscesses with normal dermis
84
What are the two most important risk factors for SAH?
Smoking and HTN
85
What causes pulmonary edema in the setting of SAH?
Increased intracranial pressure and severe over-activation of the SNS
86
What is the treatment for bacillary angiomatosis (caused by bartonella henselae)?
Erythromycin
87
What is the treatment for strongyloides infection?
Ivermectin
88
What is the treatment for onchocerciasis?
Ivermectin
89
What is the causative agent of spelunker's disease? Treatment?
Histoplasma
| Itraconazole
90
What is a major environmental risk factor for developing an acoustic neuroma?
Chronic exposure to loud noises
91
What are the s/sx of gastroparesis 2/2 DM?
Postprandial n/v, fullness, and lightheadedness (from hypoglycemia)
92
Which class of abx is classically nephrotoxic?
Aminoglycosides
93
What is the technical definition of infertility?
Inability to conceive after 12 months of unprotected sex
94
What is the difference between primary and secondary infertility?
Primary = never had kids before
95
What is the technique used to detect congenital anomalies of the uterus?
Hysterosalpingogram
96
What is the treatment for infertility 2/2 hypogonadism in women?
Clomiphene
97
Where is the mass with a bartholin's cyst?
Mass at the medial labia majora or lower vestibular area on PE
98
What is the treatment for symptomatic and asymptomatic bartholin cysts?
```
Asymptomatic = warm soaks
Abscess = I+D
```
99
When are abx indicated in the treatment of a bartholin gland abscess?
Only if cellulitis or STI present
100
True or false: BV is an infx
False-shift in vaginal flora
101
What are the risk factors for:
- BV
- Trichomonas
- Yeast infx
- BV = Douching, female sexual partner, pregnancies
- Trich = unprotected sex
- Yeast = DM, abx use, prego, steroids
102
What are the s/sx of:
- BV
- Trich
- Yeast
- BV = smelly
- trich = d/c pruritus, dysuria
- Yeast = pruritus
103
Which cause of vaginitis will produce a positive whiff test?
BV
104
What is the treatment for BV?
Vaginal metronidazole or clindamycin
105
What is the treatment for trichomonas?
Metronidazole or tinidazole
106
What is the treatment for a vaginal yeast infx?
Topical azole or fluconazole
107
What is the normal vaginal d/c for the midcycle estrogen surge?
Clear, elastic mucoid secretion
108
What is the normal vaginal d/c for the luteal phase/pregnancy?
Thick and white secretions that adhere to the vaginal wall
109
What are the four diagnostic criteria for the dx of BV? How many are needed?
```
(three of four are required):
■ Abnormal whitish-gray discharge
■ Vaginal pH > 4.5
■ ⊕ amine (whiff) test
■ Clue cells comprise > 20% of epithelial cells on wet mount
```
110
What are the four most common causes of cervicitis?
- GC/Chlamydia
- Trich
- HSV
111
What are the s/sx of cervicitis?
Yellow-green d/c with CMT
112
What are the characteristics of the ulcer with haemophilus ducreyi?
Deep, painful ulcer with irregular borders
113
True or false: smoking increases the risk of PID
True
114
What are the s/sx of PID?
- lower abdominal pain
- f/c
- Menstrual disturbances
- Purulent cervical d/c
115
What is relative positive and negative predictive value of leukocytosis in the diagnosis of PID?
Low for both
116
What are the components of the A ROPE mnemonic for causes of abdominal pain?
```
Appendicitis
Ruptured ovarian cyst
Ovarian torsion
PID
Ectopic pregnancy
```
117
What is the treatment for PID?
Ceftriaxone IM OR cefoxitin + probenecid plus doxycycline
118
What is the surgical treatment for PID?
Drainage of a tubo ovarian/pelvic abscess or TAH/BSO if severe
119
What are the s/sx of fitz-hugh-curtis syndrome?
- RUQ pain
- Perihepatitis
- elevated LFTs
120
What is the toxin that causes toxic shock syndrome?
TSST-1
121
How does toxic shock syndrome present?
■ Presents with abrupt onset of fever, vomiting, and watery diarrhea.
■ A diffuse macular erythematous rash is also seen.
■ Nonpurulent conjunctivitis is common.
■ Desquamation, especially of the palms and soles, generally occurs during recovery within 1–2 weeks of illness.
122
What is the treatment for toxic shock syndrome?
```
Rapid rehydration
Empiric abx (clindamycin + vanco)
```
123
What are the s/sx of leydig cell tumors?
Increased aromatase expression leading to increased estrogen production, and inhibited LH/FSH
124
What serum marker is found with choriocarcinomas?
beta-hCG
125
What serum marker(s) is/are found with teratomas?
Either AFP or beta-hCG
126
What serum marker(s) is/are found with seminomas?
None usual,y, but sometimes beta-hCG
127
What serum marker(s) is/are found with yolk sac tumors?
AFP
128
What is the treatment for Hep C infection for people who cannot afford a cure?
Vaccination with HAV, HBV, and avoidance of EtOH
129
What are the classic skin manifestations of leprosy?
Chronic, anesthetic, macular, hypopigmented skin lesions with raise, well demarcated borders. Nearby nerves become nodular and tender, with resultant loss of sensation.
130
How do you diagnose leprosy?
Skin bx
131
What is the treatment for leprosy?
Dapsone and rifampin
132
What are the histological findings of Crohn's disease?
noncaseating granulomas
133
Which has pseudopolyps: CD or UC
UC
134
What is the drug of choice for treating mastitis in breastfeeding mothers?
Dicloxacillin
135
What is the major side effect of TMP-SMX in pregnant women?
bilirubin is displaced from albumin, and may cause kernicterus
136
What is a major side effect of azoles?
Inhibition of p450s
137
How is phenytoin metabolized
p450 system
138
What is the first line treatment for vaginal candidiasis?
Oral fluconazole
139
What is cervical insufficiency?
Painless cervical changes that occur in the 2nd trimester and result in recurrent pregnancy loss
140
What are the most common causes of intrauterine demise in the first, second, and third trimester?
```
First = chromosomal abnormalities
Second = cervical insufficiency
Third = placental/cord complications and infx
```
141
What is cerclage performed?
2nd trimester
142
What is the effect of OCPs on maternal physiology?
Inhibition of mid-cycle LH surge 2/2 estrogen inhibition
143
What type of ovarian cancer may lead to virilization?
Sertoli-leydig cell tumors
144
Granulosa cell tumors secrete what type of hormone?
Estrogen
145
What amount of weight gain is normal for a at-weight pregnant woman?
25-35 pounds
146
What is the mainstay of treatment for sheehan syndrome?
Glucocorticoids
147
How long after exposure to varicella in a pregnant woman is IVIG able to be given?
96 hours
148
What is the treatment for a pregnant woman who has never had varicella before, who is recently exposed to it?
If less than 96 hours since exposure, then IVIG
| IV acyclovir otherwise
149
Is warfarin a contraindication to breast feeding?
No
150
Fetal accelerations of how many BPM are reassuring?
Between 120-160 with 15-25 bpm variability
151
What are the indications for an amnioinfusion?
Repetitive decelerations and treatment of chorioamnionitis
152
What are the only two safe oral DM meds in pregnancy?
Metformin
| Glyburide
153
What is the technical definition of a terminal illness?
Less than 6 months to live
154
What stage of labor is oxytocin given?
Stage I, active
155
What is the latent stage of labor?
Start of contractions to 6 cm dilation
156
What is the pharmacologic therapy for DUB that causes hemodynamic instability (after they're stabilized)? Why?
- High dose IV estrogen
| - Decreases bleeding by promoting rapid regrowth of the endometrium over the denuded epithelial surface
157
Why is progesterone not given in cases of excessive DUB?
Progestins inhibit the synthesis of estrogen receptors and increase estradiol dehydrogenase
158
Is fertility preserved after uterine artery embolization?
yes
159
When is external cephalic version offered to women?
After 36 weeks gestation
160
What is the treatment for patellofemoral pain syndrome?
Quad strengthening
161
What is the Kleihauer–Betke test?
a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother's bloodstream. It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive children
162
What tests should be ordered after a pregnancy loss?
Antiphospholipid antibody syndrome
| Fetomaternal hemorrhage if appropriate
163
What are the signs of feta; hydantoin syndrome?
Microcephaly
Midface hypoplasia
cleft lip/palate
digital hypoplasia
164
CKD causes hyper or hypocalemia? Why?
Hypo since decreased production of 1,25-vit D
165
When does gait disturbance appear with NPH: early or late in the disease course?
Early and most prominent symptom
166
What parts of the brain are most affected with NPH?
Subcortical and frontal (thus apraxia and agnosia are uncommon)
167
Which knee injury usually presents with hemarthrosis: ACL tears or MCL tears?
ACL; rarely MCL
168
True or false: polymyositis is usually painless
true
169
What is the recommended screening process for HIV per the USPSTF?
Once in ages 15-65
170
What is the current HIV screening test?
-24 antigen and HIV abs
171
What are the abx to give to cases of suspected bacterial meningitis? (3) Why these?
Cefepime-most bacterial
Vanco-resistant strep
Ampicillin-covers listeria
172
What is the abx of choice for listeria meningitis?
Ampicillin
173
How do you calculate risk?
number of people exposed and with disease, over total exposed
174
What are the criteria for getting home oxygen therapy?
Resting PaO2 less than or = to 55 mmHg
| O2 sat less than or equal to 88%
175
If a female has trich, do you need to test the male partner for trich prior to treating them? Why or why not?
No, since extremely likely they have it, and hard to get a good sample--just treat
176
What lab value is abnormal with antiphospholipid antibody syndrome?
Prolonged PTT
177
What is the diagnostic imaging modality of choice for a pt with an aortic dissection that has renal failure?
TEE
178
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: radicular pain?
Cauda equina
179
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Sudden onset back pain
conus medullaris
180
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Saddle hypo/anesthesia
Cauda equina
181
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Perianal hypo/anesthesia
Conus medullaris
182
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Asymmetric motor weakness
cauda equina
183
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: symmetric motor weakness
Conus medullaris
184
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Hypo or areflexia
Cauda equina
185
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Hyperreflexia
Conus medullaris
186
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Late onset bowel/bladder dysfunction
Cauda equina
187
Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Early onset bowel/bladder dysfunction
Conus medullaris
188
Which anti TB drug is associated with hepatitis?
All are, but INH in particular
189
True or false: even with only mild elevations in LFTs from INH therapy, INH should be stopped for second line TB therapy
False
190
True or false: oral ulcers and elevated ESR are common in celiac disease
False
191
What does the body maintain first: volume status, or electrolyte status?
Volume
192
High ADH and urine Na are characteristic of what disorder?
SIADH
193
Low ADH and urine Na are characteristic of what disorder?
DI
194
What are the two ways ADH can be stimulated?
Hypotonic
| ANG II
195
How long does it take for gout to flare completely?
12-24 hours
196
True or false: trauma/surgery can precipitate a gout attack
True
197
Pts with Chronic lymphocytic (Hashimoto's) thyroiditis are at an increased risk for what malignancy?
Thyroid lymphoma
198
What is the typical presentation of thyroid lymphoma?
Rapidly enlarging thyroid with compressive symptoms
| Systemic B symptoms
199
What causes the facial cyanosis when adducting a pts arms with thyroid lymphoma?
Compression of the subclavian vein against the thyroid
200
What is the typical presentation of Subacute (de Quervain's) thyroiditis?
Follows a recent viral infx
Painful goiter
Fever
