Uworld review 6 Flashcards
1
Q
What are the effects of thyrotoxicosis on the cardiovascular system?
A
- Wide pulse pressure
- Arrhythmias
- Increased inotropy and chronotropy
2
Q
How does thyrotoxicosis lead to increased sympathetic s/sx?
A
- Upregulates adrenergic receptors
- does NOT increase catecholamine synthesis
3
Q
What are the characteristics of condyloma latum?
A
Flattened pink or gray velvety papules on mucous membranes
4
Q
What is the best medication for the initial treatment of polymyositis?
A
Corticosteroids
5
Q
What can polymyositis be a secondary symptom of?
A
CA
6
Q
What is dacryocystitis, and what are the presenting features of it?
A
- Infection of the lacrimal sac in the medial aspect of the eye.
- Sudden onset of pain and redness in the medial canthal region, with purulent discharged noted from the punctum
7
Q
What are the usual pathogens that cause dacryocystitis, and what is the treatment?
A
- Staph aureus
- Strep
- Systemic Abx
8
Q
What is the technical definition of orbital cellulitis?
A
Infection posterior to the orbital septum
9
Q
What are the s/sx of orbital cellulitis, beside the rash?
A
- Abrupt fever
- proptosis
- Restriction of EOMs
- Edematous, erythematous eyelids
10
Q
What is a chalazion? How does it present?
A
- Chronic, granulomatous inflammation of the meibomian gland
- Painless, lid nodule, with minor lid discomfort
11
Q
What is a hordeolum?
A
-Staph/strep abscess over the eyelid
12
Q
What is episcleritis, and how does it present?
A
- Infection of the episcleral tissue between the conjunctiva and sclera.
- Acute onset of pain, photophobia, and watery d/c
13
Q
What is the most common inheritance pattern of HOCM?
A
AD
14
Q
What is the MOA and use of chlorpheniramine?
A
ANtihistamine for relief of allergy symptoms
15
Q
Muscle weakness + purple papules on the hands = ?
A
Dermatomyositis
16
Q
Which affects the ANS: dermatomyositis/polymyositis, or eaton-lambert syndrome?
A
Eaton-lambert
17
Q
Which affects reflexes: dermatomyositis/polymyositis, or eaton-lambert syndrome
A
Eaton-lambert
18
Q
What is the most sensitive test to screen for diabetic nephropathy?
A
Random urine microalbumin/Cr ratio
19
Q
How can you differentiate between tricuspid endocarditis vs perivalvular abscess?
A
- endocarditis causes a systolic murmur (tricuspid regurg), and very rarely has conduction defects
- Perivalvular abscesses produce diastolic murmurs (aortic regurg), and commonly have conduction defects
20
Q
When is the murmur associated with Aortic regurg best heard over the right and left sternal border respectively?
A
Right = aortic root disease Left = Valvular disease
21
Q
What is the classic triad of Felty syndrome?
A
- Inflammatory arthritis
- Splenomegaly
- Neutropenia
22
Q
In whom is Felty syndrome common in?
A
Pts with RA
23
Q
What are the extra articular manifestations of Felty syndrome?
A
- Skin ulcerations
- Vasculitis
24
Q
What is type I and II of heparin induced thrombocytopenia (HIT)?
A
I = nonimmune direct effect of heparin on platelet activation II= antibodies form to platelet factor 4, complexed with heparin
25
How long doe HIT usually take to manifest?
5-10 days
26
When is the osmolar gap useful?
If ethanol, methanol, or ethylene glycol toxicity is suspected
27
What is the use of a urine anion gap?
Helps determine if a normal anion gap acidosis is d/t the renal on intestinal bicarb losses. Renal loss occur with bicarb loss
28
What is the basic workup of HTN to r/o obvious other causes? (4)
- EKG
- UA
- CMP
- Lipid panel
29
When is a renal US done in the workup of HTN?
If creatinine is elevated or abnormal UA
30
What is the first step in the workup of a possible malignant pleural effusion?
Thoracentesis
31
What type of pleural effusion are malignant pleural effusions (exudative vs transudative)?
Exudative
32
What are the advantages of thoracentesis vs bronchoscopy in the workup of a pleural effusion?
Thoracentesis is done at the bedside, and does not require sedation
33
True or false: presbycusis can present with tinnitus
True
34
Rhomboid crystals are characteristic of gout or pseudogout?
Pseudogout
35
What are the other articular manifestations of pseudogout?
Chondrocalcinosis
36
What are the characteristics of the effusion with pseudogout?
Inflammatory: 15-30 cells/mm^3
37
True or false: Heberden nodes are associated with pseudogout
False
38
What are the shapes of the crystals in gout and pseudogout respectively?
```
Gout = needles
Pseudogout = rhomboid
```
39
What causes parotid gland enlargement with alcoholic liver cirrhosis?
Alcohol use causes fat deposition. Liver cirrhosis not directly related.
40
True or false: all patients with liver cirrhosis should undergo screening endoscopy
True
41
What is the prophylaxis for esophageal varices 2/2 alcoholic liver cirrhosis? (2)
Banding or nonselective beta blockers (e.g. nadolol)
42
How do beta blockers prevent esophageal variceal rupture?
Reduce portal venous pressure by blocking the adrenergic vasodilatory response of the mesenteric arterioles, and leaving only alpha vasoconstriction, lower blood flow through the varices
43
What is the formula for the alveolar gas equation on RA under normal circumstances?
150 - (PaCO2)/0.8
44
What sort of hepatic abscess classically can cause anaphylaxis?
Echinococcal cysts
45
What type of neck tumor produces calcitonin? Why?
Medullary thyroid CA
| Hyperplasia of the parafollicular C cells
46
What are the cells in the thyroid that produce calcitonin?
Parafollicular C cells
47
What are the classic symptoms of secretory diarrhea?
Watery diarrhea that *wakes pt up*
48
What is the stool osmotic gap, and what is its use?
-difference between plasma osmolality (= to stool osmolarity) and double the sum of Na and K ions in stool (= to stool osmolality)
49
What happens to the stool osmotic gap with secretory diarrhea?
Secretory diarrhea is due to increased secretions of ions. Thus the difference between plasma osmolality and measured fecal Na and K is significantly *reduced*
50
What happens to the stool osmotic gap with osmotic diarrhea?
Non Absorbed and unmeasured osmotically active agents are present in the GI tract. These ions result in an elevated osmotic gap (over 125)
51
Postsurgical changes the the bowel classically result in what sort of diarrhea (secretory or osmotic)?
Secretory
52
What are the ALT, AST, and alk phos levels with Dubin Johnson and Rotor's syndrome?
All normal
53
How can you differentiate between thyrotoxic myopathy vs polymyositis?
Thyrotoxic will have systemic s/sx, and may have exaggerated DTRs (although usually not)
54
Are gout crystals positively or negatively birefringent? What does this mean?
Negative (yellow in parallel light, blue to orthogonal)
55
What are the Ca and phosphorus levels with secondary hyperPTH 2/2 CKD?
Low to normal Ca
| Low Phosphorus
56
What are the PTH levels with hypercalcemia of malignancy?
Low
57
What is the first step in working up Cushing's syndrome? (3)
One of the following:
- Overnight low-dose dexamethasone suppression test
- Salivary cortisol assay
- 24 hour free cortisol measurement
58
Once a diagnosis of hypercortisolism is established, what is the next step in the workup?
ACTH levels
59
What is the role of early morning cortisol levels?
Low utility in the evaluation of hypercortisolism
60
What are the morphologic characteristics of nocardia? What is the classic presentation for this infection?
- Gram positive, partially acid-fast rods that form filamentous structures
- Pneumonia in a immunocompromised pt (e.g. kidney transplant)
61
What is the treatment for nocardia?
TMP-SMX
62
What are the CXR findings of a pt with nocardiosis?
Nodular or cavitating lesions
63
What are the classic s/sx for a bony met to the spine?
- unrelenting back pain that is not relieved by rest.
- Worse at night
- Point TTP
64
How can you differentiate between a fat embolism and anaphylaxis?
Fat embolism has a petechial rash
Anaphylaxis has erythematous wheals and urticaria
Fat emboli also take 12-24 hours to manifest
65
How long do fat emboli take to manifest?
12-24 hours
66
What is the percentage of 1, 2, and 3 SDs?
```
1 = 68%
2 = 95%
3 = 99.7%
```
67
A stable lung lesion over how many years is considered benign, and indicates no further testing?
2-3 years
68
If a pt has a newfound lesion on CXR with no prior to compare to, what is the next step?
chest CT
69
What is the follow up for a lung nodule that has benign features on CT? Intermediate? Malignant?
```
Benign = serial CTs
Intermediate = bx or PET
Malignant = surgery
```
70
Why can some pts with SLE have pancytopenia?
Autoimmune peripheral destruction
71
Why is bone marrow bx frequently done with SLE?
since pancytopenia can occur, done to r/o other malignancies
72
What is the treatment for syphilis in a pt with a PCN allergy? What if they're pregnant?
- Doxycycline
| - PCN desensitization if prego
73
What are the indications for PCN desentization for the treatment of syphilis in a pt with a PCN allergy?
- Pregnant
| - have neurosyphilis
74
How do Lewy bodies appear on histologic examination/.
Eosinophilic intracytoplasmic inclusions
75
What is the reversal agent for TCA overdose? How does this work?
Bicarb
| Alleviates the inhibitory action of TCAs on fast Na channels of the myocardium
76
QRS interval increase of what is an indication for bicarb?
Over 100 msec
77
What causes seizures with TCA overdose? What does this mean in terms of treating seizures?
Inhibition of GABA receptors
| So benzos preferred over Na channel blockers
78
What is the treatment for acute graft rejection?
IV steroids
79
*What is a common adverse effect of cyclosporine in the early days of a transplant? What is the treatment?*
* -Drug is nephrotoxic, and can damage kidney, leading to oliguria, HTN etc.
- Decrease dose after r/o acute rejection*
80
What is the correction for Na with hyperglycemia?
For every 100 mg/dL of glucose over 100, there is a loss of 2 mEq/L of Na. Thus real Na = measured Na +
(measured glucose -100)/*2/100
81
What is the management for symptomatic PACs?
Beta blockers
82
Nephrotic syndrome + palpable kidneys + Hepatomegaly + Ventricular hypertrophy in the setting of chronic inflammation is suggestive of what?
Amyloidosis
83
When is an echo indicated for the workup of PACs?
If structural abnormality of the heart is suspected
84
What is the treatment for nephrotic syndrome 2/2 amyloidosis?
Colchicine and treatment of underlying inflammatory disease
85
How is amyloidosis diagnosed?
Fat pad bx
86
What are the dermatologic manifestations of amyloidosis?
Waxy skin with easy bruising
87
How doe NTG relieve ischemic chest pain?
Reduces preload and afterload and thus oxygen demand of LV
88
What additional drug is used in the treatment of cocaine induced myocardial ischemia?
Benzos (reduces sympathetic outflow)
89
What are the fundoscopic findings of GCA?
Swollen, pale disk
90
Is acetazolamide used to treat open or closed angle glaucoma?
Open
91
What is the treatment for myasthenic crisis unresponsive to pyridostigmine?
Therapeutic plasma exchange (preferred) or IVIG, and corticosteroids
92
What is the classic tetrad of PD?
- Resting tremor
- Postural instability
- Rigidity
- Bradykinesia
93
How can you differentiate a cerebellar tremor vs PD?
Cerebellar tremors are usually accompanied by other s/sx, like nystagmus, ataxia, dysmetria etc.
94
For which type of cancer is treatment of H.pylori curative?
MALT lymphoma, for some patients
95
What is the role of somatostatin in the treatment of ruptured esophageal varices?
Prevents release of vasodilatory molecules
96
When is the Minnesota/ sengstaken-Blakemore tube used to treat esophageal varices?
If hemodynamically unstable, and actively bleeding
97
When should a pt with an acute COPD exacerbation be intubated? (3)
- AMS
- Profound acidemia (pH less than 7.1)
- Hemodynamically unstable
98
How do vagal maneuvers stop SVTs?
Increase parasympathetic tone in the heart, and result in a temporary slowing of conduction in the AV node, and an increase in AV node automaticity
99
What are the s/sx of pHTN?
- RIght ventricular heave / hypertrophy
- Loud P2, right sided S3
- Tricuspid regurg murmur
- Fluid overload/HF symptoms
100
What is the treatment for pHTN 2/2 LV dysfunction?
ACEIs and diuretics
101
What is the treatment for idiopathic pHTN?
Endothelin receptor antagonists (Bosentan)
| PDE-5 inhibitors
102
What is the mechanism by which sarcoidosis causes hypercalcemia?
Increased 1-alpha hydroxylase expression
103
When is sarcoidosis treated?
If symptomatic.
104
What is the MOA and use of apixaban?
Factor X inhibitor
105
What are the s/sx of chronic prostatitis?
- Pelvic pain
- Painful ejaculation
- Back pain
106
Is the prostate enlarged with chronic prostatitis?
No
107
What are the UA findings of chronic prostatitis?
Leukocytes, but no bacteria or other infx
108
What is the first step in the workup of acute oliguria?
Bladder scan with f/u cath if full or equivocal
109
What foods (besides honey) are associated with botulinum poisoning?
Canned foods
110
What are the s/sx of botulinum poisoning? (6)
- Bilateral cranial neuropathies
- Symmetric descending weakness
- Diplopia
- Facial weakness
- dysphagia/dysarthria
111
What is the MOA of botulinum toxin?
Inhibits presynaptic ACh release and the NMJ
112
What is the treatment for botulinum poisoning?
Horse-derived (equine) antitoxin
113
What is the MOA and use of pralidoxime?
2PAM (reactivates acetylcholinesterase for anti acetylcholinesterase poisoning
114
What are the s/sx of oropharyngeal dysphagia, and what is the appropriate test to diagnose it?
- Difficulty *initiating* swallowing, causing regurg
| - Videofluoroscopic Ba swallow
115
What are the s/sx of esophageal dysphagia?
-Dysphagia that is with completion of swallowing, withOUT cough, choking, or nasal regurg.
116
What is the diagnostic test for esophageal dysphagia to solids only, progressing to liquids? To both at onset?
- Solids only = mechanical obstruction, Upper endoscopy
| - Both = Ba swallow followed by manometry
117
What are the s/sx of a benzo overdose?
Like being drunk
118
What are the s/sx of phenytoin overdose? (3)
- Horizontal nystagmus
- Cerebellar ataxia
- confusion
119
How does Li overdose present? (3)
- Hyperreflexia
- Tremors
- Seizures
120
What are the relative serum complement levels with IgA nephropathy?
Normal
121
How can you differentiate between IgA nephropathy and postStrep? (onset, complement levels)
- Strep = 10-20 days after infx, low complement levels
| - IgA = soon after infx, normal complement levels
122
What is the diagnostic test of choice for esophageal rupture?
CT or contrast esophagography with gastrografin
123
What are the s/sx of entamoeba histolytica? What type of organism is it?
- Protozoan
| - colitis, or extraintestinal (liver, brain, pleura) disease from abscess
124
What is the treatment for a hepatic cyst caused by entamoeba histolytica?
Metronidazole and intraluminal antibacterial
125
How can you differentiate between a hepatic cyst caused by entamoeba histolytica vs echinococcus granulosus? (3, onset and associated symptoms)
```
Entamoeba = asymptomatic for weeks, then fevers, diarrhea.
Echino = asymptomatic for years. No fever unless rupture, no diarrhea.
```
126
What is the most appropriate initial screening test for thalassemias?
CBC, unless of african descent. Then CBC + pts hb electrophoresis
127
How do beta blockers cause hyperkalemia?
Interfere with beta-2 mediated intracellular K uptake
128
What is the most common cause of hyperkalemia?
Renal disease causing decreased excretion
129
When is hyperkalemia treated with Ca gluconate?
EKG changes, or above 7.0
130
How can NSAIDs cause hyperkalemia?
Impair local prostaglandin synthesis and reduce RAAS
131
Urinary 5 HIAA is seen with what disease?
Carcinoid syndrome
132
What are the classic s/sx of a glucagonoma? (5)
- Mild DM
- Necrolytic, migratory erythema
- Weight loss
- Diarrhea
- Anemia
133
True or false: sensation and reflexes are intact with myasthenia gravis
True
134
True or false: reflexes are intact with Guillain-Barre
False
135
What are the pyramidal tract s/sx?
*Pronator drift*
focal weakness
Spasticity
Babinski sign
136
Where is the lesion with a positive pronator drift?
Pyramidal tract
137
What is the pyramidal tract?
Corticospinal and corticobulbar tracts
138
Why must eyes be closed to perform the pronator drift test?
So that only rely on *proprioception*, not visual input
139
What is the best diagnostic test for diverticulitis?
Abdo CT with IV and oral contrast
140
What are the amino acids that are not uptaken with cystinuria?
Cysteine
Ornithine
Arginine
Lysine
("COAL")
141
What are the shape of the crystals with cystinuria?
Hexagonal
142
What is the urinary cyanide nitroprusside test?
Detects the presence of cystine levels
143
What is shift work sleep disorder?
Recurrent pattern of sleep interruption due to shift work, causing difficulties in initiating and maintaining sleep
144
What is the difference between toxic epidermal necrolysis and SJS?
TEN is over 30% surface area
| SJS is less than 10%
145
What is senile purpura, and what causes it?
- Skin fragility characterized by ecchymoses, hyper pigmentation (hemosiderin) and normal labs.
- Perivascular CT atrophy part of normal aging and sunlight exposure
146
How does prazosin cause prazosin?
alpha 1 blockade
147
What is the classic triad of symptoms for Wernicke's encephalopathy?
- Confusion
- horizontal nystagmus
- gait Ataxia
148
What causes Wernicke's encephalopathy?
Thiamine deficiency
149
What is the Hawthorn effect?
Tendency of a study population to affect outcome because they are aware they are under observation
150
What is information bias?
Imperfect assessment of association between the exposure and the outcome as a result of errors in the measurement of exposure and outcome status
151
What causes progressive multifocal leukoencephalopathy?
JC virus reactivation in immunosuppressed (Classically HIV) pts, causing *white matter demyelination*. Presents with focal neurologic deficits.
152
What are the presenting s/sx of progressive multifocal leukoencephalopathy?
-Focal findings
| -
153
What are the head CT findings of reactivated toxoplasmosis?
Multiple, *ring-enhancing* lesions with *edema*
154
What are the head CT findings of progressive multifocal leukoencephalopathy?
Multiple, *non*-enhancing lesions withOUT edema
155
What is the treatment for progressive multifocal leukoencephalopathy in AIDS pts?
HAART
156
How do you definitively diagnose progressive multifocal leukoencephalopathy?
LP with JC virus
157
What is central cord syndrome, and what causes it? S/Sx?
Hyperextension injury in the cervical spine (typically) causes selective damage to the central portion of the anterior spinal cord, specifically the central portions of the corticospinal tracts and the decussating fibers of the lateral spinothalamic tract
-Loss of UE movements, but LE somewhat intact, since UE are in the middle of the tract
158
What is postcholecystectomy syndrome, and what causes it?
- Gallbladder like-pain s/p cholecystectomy
| - Biliary (retained duct system), biliary dyskinesia, or extrabiliary (pancreas, PUD).
159
What is the treatment/diagnostic test for postcholecystectomy syndrome?
ERCP
160
What are the labs like with postcholecystectomy syndrome?
Can show elevated bili and alk phos
161
What are the differences between CML and AML in terms of:
- WBC count
- Auer rods
- Basophils
- Leukocyte alk phos score
- WBC less than 100,000 in AML, but higher in CML
- Auer rods in AML, not in CML
- Basophilia in CML, not in AML
- Low leuk phos score in AML
162
Why does excessive vomiting present with hypokalemic hypochloremia?
KCl is salt in gastric juices, along with HCl
163
If RAAS is activated, what happens to Bicarb?
MOre is reabsorbed (contraction alkalosis)
164
What is the most common cause of esophagitis in HIV pts with and without dysphagia?
```
Candida = without dysphagia
CMV = WITH dysphagia
```
165
What size of PPD induration is considered positive for: HIV+ patients
5 mm
166
What size of PPD induration is considered positive for: Recent contacts of known TB cases
5 mm
167
What size of PPD induration is considered positive for: Nodular or fibrotic changes on CXR c/w previously healed TB
5 mm
168
What size of PPD induration is considered positive for: Organ transplant recipients and other immunosuppressed pts
5 mm
169
What size of PPD induration is considered positive for: Recent immigrants (less than 5 years) from TB endemic area
10 mm
170
What size of PPD induration is considered positive for: Injection drug user
10 mm
171
What size of PPD induration is considered positive for: Residents and employees of high risk settings (prisons, RN homes, hospitals, homeless shelters)
10 mm
172
What size of PPD induration is considered positive for: Mycobacterial lab personnel
10 mm
173
What size of PPD induration is considered positive for: Those at higher risk for TB reactivation (DM, prolonged steroid use, leukemia, ESRD)
10 mm
174
What size of PPD induration is considered positive for: Children less than 4, or those exposed to adults in high risk categories
10 mm
175
What is the next best step in the workup of pancreatitis if LFTs are elevated, but bili is normal?
RUQ US
176
How does uremia cause coagulation issues?
Interferes with platelet aggregation
177
Which coagulation lab is abnormal with uremic coagulopathy?
Bleeding time (PT and PTT are normal)
178
What is the nidus for infection with Ludwig's angina?
Tooth root
179
What is the confirmatory test for Ludwig's angina?
CT
180
What is the treatment for Ludwig's angina?
IV Abx, like clinda (not usually surgery)
181
What is the normal evolution of the rash with Chancroid?
Papules to pustules
182
Which immunosuppression is known for its nephrotoxic effects?
Cyclosporine
183
What are the major side effects of azathioprine? (3)
- Diarrhea
- leukopenia
- Hepatotoxic
184
Which is more nephrotoxic: tacrolimus or cyclosporine?
Cyclosporine
185
Which causes hirsutism: tacrolimus or cyclosporine?
Cyclosporine
186
Which is more *neurotoxic: tacrolimus or cyclosporine
Tacrolimus
187
When should pts with a close relative to colon cancer pt be screened with colonoscopy?
10 years prior to their age of diagnosis, or 40
188
Which has canker sores: UC or CD?
CD
189
What are the urinary findings/lab of diabetic nephropathy?
Proteinuria without hematuria
| Elevated creatinine
190
What is the pathophysiology of diabetic nephropathy?
Microangiopathy from glycosylation
191
What is the requirement for hospice care?
Pt has a prognosis of less than 6 months
192
True or false: focal neurologic deficits are uncommon with SAH
True
193
What are the head CT findings of SAH?
White stuff in the ventricles and the cisterns
194
What is the best test to monitor the progress of treatment for DKA?
Serum anion gap and beta hydroxybutyrate
195
What antibody is elevated with Hashimoto's? What effect can this have on women?
Anti-TPO
| Recurrent miscarriages
196
What is the effect of pH on Ca levels?
Increased pH causes increased Ca binding to albumin and vice versa.
This happens because when H+ bind or unbind, Ca takes its place.
197
What is the first line treatment for cognitive symptoms in Alzheimer's disease? What drugs are usually used (3)?
Anticholinergics like donepezil, rivastigmine, and galantamine
198
Are DTRs normal with a myasthenic crisis? Guillain barre?
Normal with myasthenic crisis
| Decreased with GB
199
Which abx classically sets of a myasthenic crisis?
Fluoroquinolones
200
What is the first step in treating hypercalcemia of malignancy? After that?
1. IVFs
2. Calcitonin
3. Bisphosphonates
201
Why are loop diuretics not usually used for treating hypercalcemia of malignancy?
Volume depletion makes things worse
202
When does creatinine spike with contrast induced nephropathy? What is the preventative treatment for this?
- 24 hours after administration
| - IVFs and N-acetylcysteine
203
What is the order of measures to lower BP?
1. Weight loss
2. DASH diet
3. Exercise
4. Dietary Na control
5. Alcohol
204
Who is recommended to get the PCV13 and PCV23?
PCV13 = for those age 65+, or high risk immunocompromised
PCV23 = all pts who are immunocompromised
