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Uworld/ Rx review Flashcards

1
Q

What are the components of the CURB-65 criteria?

A 
Confusion
Uremic (BUN over 19)
Respiratory rate above 30 bpm
SBP less than 90 or DBP less than 60
Age over 65
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2
Q

What are the three classic symptoms of Zn deficiency?

A

Dermatitis
Diarrhea
Alopecia

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3
Q

What is the screening test, and what is the diagnostic test for acromegaly?

A 
Screening = ICF-1 assay
Diagnostic = glucose tolerance testing
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4
Q

What is the role of Cr in the body?

A

Glucose tolerance–deficiencies will lead to glucose and lipid disturbances

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5
Q

What is the risk of high and low Co in the body?

A 
High = cardiotoxic
Low = nothing
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6
Q

What is the risk of high and low Cu in the body?

A 
High = Wilson's disease
Low = anemia, neutropenia
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7
Q

What is the risk of low Se in the body?

A

Deficiency can lead to cardiomyopathy and skeletal muscle dysfunction

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8
Q

An aneurysm of what artery can cause CN III palsies?

A

Posterior communicating artery

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9
Q

What are the abx of choice for Neisseria Gonorrhoeae?

A

Cephalosporins

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10
Q

What are the abx of choice for Chlamydia trachomatis?

A

Tetracyclines

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11
Q

What is the treatment for BV?

A

Metronidazole

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12
Q

What is the treatment for patient’s with a h/o PID, who want to become pregnant?

A

IVF

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13
Q

What is the MOA and use of clomiphene?

A

Estrogen receptor modulator that increases gonadotropin release and induces ovulation

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14
Q

What is the treatment for postmenopausal symptoms?

A

SSRIs (NOT estrogen/progesterone)

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15
Q

What is the difference in laboratory findings between Ehrlichiosis and RMSF?

A

Leukopenia occurs with ehrlichiosis, while hyponatremia and thrombocytopenia may occur with RMSF

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16
Q

What are the s/sx of tularemia?

A

Fever
pneumonia
Lung issues

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17
Q

What is a kerion?

A

boggy, tender, and exudative nodule that may occur in response to gunal tinea capitis infection

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18
Q

What is Black dot tinea capitis?

A

Tinea cause by Trichophyton tonsurans, causing scattered alopecia that does not resolve with topical antifungals, and causes hair to break off near the base of the hair

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19
Q

What is the bacteria that most commonly infects human bites?

A

Eikenella corrodens

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20
Q

What are the HACEK organisms?

A 
haemophilus
Actinobacteria
Cardiobacterium
Eikenella
kingella
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21
Q

Pain in lymph nodes following alcohol consumption is pathognomonic for what?

A

Hodgkin’s lymphoma

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22
Q

What skin disease is associated with ulcerative colitis?

A

Pyoderma gangrenosum

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23
Q

What is the characteristic EEG findings of an absence seizure?

A

3 hz spike and slow wave

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24
Q

Periodic complexes, sharp EEG deflections occurring isolated, in pairs, or as triplets = ?

A

CJD

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25
Q

True or false: in cases of CO poisoning, arterial blood oxygen will be normal

A

True–CO does not affect the concentration of dissolved oxygen in the serum

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26
Q

What causes the increased anion gap with CO poisoning?

A

Lactic acid buildup

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27
Q

What is type I renal tubule acidosis?

A

Defect in distal hydrogen intercalated cells

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28
Q

What is type II renal tubule acidosis?

A

Defect in proximal bicarbonate resorption

Leads to acidemia and increased bone turnover

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29
Q

What is type IV renal tubule acidosis?

A

Deficiency of, or resistance to, aldosterone.

results in hyperkalemia

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30
Q

Amp B causes what type of kidney injury?

A

type I RTA

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31
Q

What is leukocytoclastic vasculitis?

A

Inflammatory reaction in small vessels, in organ systems like the skin and kidney.

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32
Q

What is the treatment for wet macular degeneration?

A 
VEGF inhibitors (ranibizumab or bevacizumab)
Thermal laser photocoagulation
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33
Q

What is the role of flow cytometry in diagnosing myelogenous leukemia?

A

None–used to see monoclonality in LEUKOcytes

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34
Q

What is the classic presentation of CML?

A

Neutrophilic leukocytosis and a left shift

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35
Q

What are the relative levels of leukocyte esterase in CML vs a leukemoid reaction?

A

High in leukemoid rxn

Low in CML

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36
Q

What is the treatment for CML?

A

Imatinib

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37
Q

Gynecomastia is associated with what type of lung cancer? How?

A

Adenocarcinoma

Produces Beta-human chorionic gonadotropin

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38
Q

What is the diagnostic test of choice for a pheo if high clinical suspicion? Low?

A 
High = Plasma fractionated free metanephrine levels
Low = 24-hour urine catecholamines/metanephrine
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39
Q

What drug is classically associated with membranous nephropathy?

A

Penicillamine

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40
Q

What are the classic side effects of methotrexate?

A

Pulmonary fibrosis

Megaloblastic anemia

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41
Q

What is the confirmatory test for HIV?

A

HIV1/HIV2 antibody test–NOT western blot

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42
Q

What is the psychopathology of red man syndrome?

A

Direct stimulation of mast cells by vancomycin

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43
Q

What is the reversal agent for beta-blocker overdose in severe cases?

A

Glucagon

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44
Q

What is the first line treatment for beta blocker overdose?

A

Isoproterenol

Atropine

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45
Q

What are the only two therapies that have proven survival benefit in COPD patients?

A

Oxygen and smoking cessation

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46
Q

What are the enzymatic and electrolyte changes associated with sarcoidosis?

A

Hypercalcemia

Increased ACE

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47
Q

What causes the hypercalcemia in sarcoidosis?

A

Increased production of 1,25 vit D by macrophages in the granulomas

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48
Q

What is the treatment for Mycosis fungoides that is limited to the dermis/epidermis?

A

Local nitrogen mustards

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49
Q

What is the treatment for Sezary syndrome?

A

Systemic chemo

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50
Q

What happens to DLCO in restrictive lung disease 2/2 obesity? D/t rheumatoid?

A

Obesity has normal DLCO

Rheumatoid has decreased DLCO

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51
Q

Optic gliomas are seen in NF1 or NF2?

A

NF1

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52
Q

Meningiomas are seen in MF1 or NF2?

A

NF2

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53
Q

What mm of induration for a PPD test is considered positive in a health care worker?

A

10 mm or greater

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54
Q

What are the indications for surgical intervention with PAD?

A

Rest pain
Nonhealing ulcers
Disabling claudication

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55
Q

When is a HIDA scan indicated in the work up of suspected cholecystitis?

A

If the US is equivocal

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56
Q

What is the most common bacteria to cause infective endocarditis with preexisting valve disease? What is the treatment for this?

A

Strep viridans

PCN G

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57
Q

What is the usual group of bacteria that causes infective endocarditis on prosthetic valves? What is the treatment for this?

A

Coagulase negative staph

Vancomycin

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58
Q

Enterococci infective endocarditis is seen in whom?

A

Patients with a h/o bowel surgery

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59
Q

What bacteria is implicated in infective valve disease associated with drug use?

A

Staph aureus

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60
Q

Which is more fatal: lymphocyte rich or poor Hodgkin’s lymphoma?

A

Lymphocyte depleted

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61
Q

What are the first and second line treatments for symptomatic sarcoidosis?

A

Prednisone

Methotrexate

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62
Q

What is the typical presentation of a Zenker’s diverticulum? (3)

A

Severe halitosis
spitting up of pills with mucus
Slow, progressive dysphagia

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63
Q

Which generally presents with mouth ulcers: CD or UC?

A

CD

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64
Q

What is post-transplant lymphoproliferative disorder?

A

Lymphoid/plasmacytic proliferations that occur in organ or hematopoietic stem cell transplant 2/2 chronic immunosuppression

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65
Q

What is the MOA and use of rituximab?

A

Anti-CD-20 antibody used to immunosuppression

Binds to CD20 on B cells, causing complement activation and killing

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66
Q

What are the s/sx of conduction aphasia?

A

Impaired repetition, but intact fluency and comprehension

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67
Q

What are the of the brain is implicated in broca’s aphasia? What vessel?

A

Right superior division of the middle cerebral artery

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68
Q

What metabolic disturbance is seen in sarcoidosis? Why?

A

Hypercalcemia

Granuloma produces 1,25 vit D3

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69
Q

What is the treatment for hypercalcemia?

A

IVFs

Calcitonin

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70
Q

What is the treatment for budd-chiari syndrome?

A

tPA and anticoagulation

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71
Q

What is the general presentation (labs wise) for budd-chiari syndrome?

A

Mildly elevated LFTs
Elevated alk phos
Tons of collateral veins in the liver on imaging

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72
Q

What is the best way to evaluate suspected bladder trauma?

A

Cystogram

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73
Q

What is the management for intraperitoneal vs extraperitoneal bladder rupture?

A 
Intraperitoneal = surgical
Extraperitoneal = Indwelling foley
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74
Q

What is the major risk factor for medullary carcinoma of the thyroid?

A

Genetic predisposition (MEN2a/2B)

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75
Q

What are the effects on the bowel of hypercalcemia?

A

Constipation

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76
Q

What is the MOA and use of bosentan?

A

Competitive endothelin-1 antagonist used to alleviate the effects of systemic sclerosis pHTN

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77
Q

What is the first line treatment for CREST syndrome?

A

Amlodipine

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78
Q

What is the treatment of raynaud phenomenon?

A

CCBs

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79
Q

How long must one wait to be put on an organ transplant list after having chemo for a cancer?

A

5 years

Otherwise ABSOLUTE contraindication

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80
Q

What is the abx of choice for a human bite?

81
Q

What is the general treatment for pericarditis?

A

NSAIDS + colchicine

82
Q

When is drainage indicated for pericarditis?

A

More than 2 weeks duration, signs of tamponade, or purulent

83
Q

What is the abx of choice for salmonella osteomyelitis in children?

A

Ceftriaxone

84
Q

What is the problem with using fluoroquinolones in children?

A

Bone development problems

85
Q

Why do some women develop transient hyperthyroidism early in pregnancy?

A

Increase beta-HCG activates TSH receptors (because CHG has a similar alpha subunit)

86
Q

What is the effect of estrogen on thyroid binding globulin?

A

Increases production and decreases clearance (increases total T3/T4, but not free levels)

87
Q

What is the drug of choice for trigeminal neuralgia?

A

Carbamazepine

88
Q

What is the first line pharmacotherapy for BPH?

A

alpha antagonists

89
Q

What is the chromosomal aberration in APML?

90
Q

Why is APL a medical emergency?

A

Hemorrhage from coagulopathy

91
Q

What is the issue with treating APL with daunorubicin?

A

Increased risk of DIC

92
Q

What happens to EF with restrictive cardiomyopathy?

93
Q

Is there any benefit of prophylactic abx for second degree burn?

94
Q

When is amp B used to treat coccidioidomycosis?

A

Only if rapidly deteriorating, or affecting vital sites, like meninges, spine, etc. Otherwise azoles are first line

95
Q

What are the three major cardiac damage markers, and when do they subside?

A

Myoglobin - few hours
CK - few days
Troponin - week

96
Q

Where is Broca’s area located?

A

Posterior inferior frontal gyrus

97
Q

Where is Wernicke’s area located?

A

Posterior superior temporal lobe

98
Q

What are of the brain leads to conduction aphasia?

A

Arcuate fasciculus

99
Q

What sort of ear discharge is associated with fungal otitis externa?

A

black (or white), fluffy exudates

100
Q

What is the color of the exudate of pseudomonas otitis externa?

101
Q

What is the expected HCO3 change (renal compensation) with PaCO2 change?

A

d(HCO3) = 0.2 * d(PaCO2)

102
Q

What is the role of [d(anion gap) / d(HCO3)] ?

A

If the value is greater than 2, there is combined anion gap metabolic acidosis , and concurrent metabolic alkalosis, because the reduction in bicarb is less than it should be

103
Q

What pneumoconiosis increases the risk for TB?

104
Q

What is the equation for corrected calcium?

A

Corrected Ca = serum Ca + 0.8(4-albumin)

105
Q

What is the first step in treatment of hypercalcemia? Why?

A
  • NS

- Decreased volumes decreases ability of the kidney to excrete Ca

106
Q

After NS administration, what is the second step for treating hypercalcemia?

A

Bisphosphonates

107
Q

What is the MOA of -dronate drugs?

A
  • Bisphosphonates

- Inhibit osteoclast resorption of bone

108
Q

What are the EKG findings of hyperkalemia? (3)

A

Tall, peaked T waves
Wide QRS
Flat P waves

109
Q

What are the EKG findings of hypocalcemia?

A

QT prolongation

110
Q

What is the PaO2:FiO2 ratio in ARDS?

A

Less than 200 mmHg

111
Q

Which loop diuretic is not a sulfa drug?

A

Ethacrynic acid

112
Q

When is treatment for CLL initiated?

A

Only when the patient becomes symptomatic, is anemic, or thrombocytopenic

113
Q

What is the next step in treatment of acne if topical therapy fails?

A

Oral tetracyclines

114
Q

What is the treatment for Wegener’s granulomatosis (granulomatosis with polyangiitis)?

A

Oral cyclophosphamide and corticosteroids

115
Q

Hypomagnesemia commonly causes what other electrolyte abnormality? How?

A
  • Refractory hypokalemia

- Magnesium deficiency impairs Na-K-ATPase, which would decrease cellular uptake of K

116
Q

What is the basis of the secretin test in diagnosing gastrinomas?

A

Administering secretin should decrease gastrin secretion. If it does not (positive test), suggests gastrinoma

117
Q

What is the abx of choice for S aureus endocarditis?

A

Gentamicin

118
Q

What is the major risk of untreated subclinical hyperthyroidism in the elderly?

A

Cardiac dysrhythmias

119
Q

What is the treatment for PCP?

A

TMP-SMX + prednisone

120
Q

What is the DOC for CHF exacerbation?

A

Lasix (furosemide)

121
Q

What are the drugs used to treat acute CHF exacerbation?

A

Lasix
Dobutamine
Nitroprusside

122
Q

What is the role of HCTZ in the management of CHF?

A

Good for long term control, not indicated in acute exacerbations

123
Q

What is the inheritance pattern of HD?

A

Autosomal dominant (but 50% chance of inheritance since two alleles)

124
Q

What is the treatment for a PE?

A

Warfarin with enoxaparin bridging

125
Q

When is embolectomy indicated for the treatment of a PE?

A

Hemodynamically unstable, and does not respond to medical therapy

126
Q

When is tPA indicated for the treatment of a PE?

A

If hypotensive

127
Q

Brown bone tumors are the result of what process?

128
Q

What is the treatment for AKI in multiple myeloma patients?

A

Aggressive hydration

129
Q

What, generally, is the treatment for multiple myeloma?

A

Alkylating agents + prednisone

130
Q

When is hemodialysis indicated fro AKI 2/2 multiple myeloma?

A

If aggressive hydration fails

131
Q

What is the major adverse effect of penicillamine?

A

Aplasic anemia

132
Q

What are the three major adverse effects of deferoxamine?

A

Urine discoloration
Growth retardation
Hearing loss

133
Q

What is the treatment for GVHD?

134
Q

What is the best test to assess for ulnar nerve motor function?

A

Abduction of the second and third digits

135
Q

Extension of the 5th digit is supplied by what nerve?

A

Radial nerve

136
Q

What other major artery can possibly be affected by giant cell arteritis?

137
Q

When does common variable immunodeficiency usually present? What are the s/sx?

A

50-60s
Infections
LAD

138
Q

What is the malignancy that patients with CVID are predisposed to?

139
Q

What is the treatment for impetigo?

A

Topical mupirocin x5 days

140
Q

What is the treatment for optic neuritis for the acute phase?

A

IV methylprednisone

141
Q

What is pulsus paradoxus indicative of?

142
Q

What causes the flushing that occurs with niacin use, and what can be done to prevent it?

A

Increased prostaglandins

ASA

143
Q

What is Kluver-Bucy syndrome, and what are the s/sx?

A

Temporal lobe dementia

Hyperorality, hypersexuality, apathy, amotivation

144
Q

What is the treatment for tumor lysis syndrome?

A

IVFs and allopurinol

145
Q

What extra heart sound is heard with restrictive cardiomyopathy?

146
Q

What is the Jarisch-Herxheimer reaction?

A

Sudden worsening of symptoms of secondary syphilis with the administration of PCN. Result of killed organisms releasing a pyrogen

147
Q

Morning joint stiffness that lasts more than how long is suggestive of RA?

A

More than 30 minutes (less than this is c/w OA)

148
Q

What are the s/sx of the JC virus?

A

UMN lesions and white matter lesions on MRI

149
Q

What visual deficit may be seen with a lesion to Wernicke’s area?

A

Superior quadrantanopia (damage to Meyer’s loop)

150
Q

Pure motor deficit stroke is associated with what type of lesion?

A

Lesion to the internal capsule

151
Q

Pure sensory strokes are associated with a lesion where?

152
Q

Infarct in the pons produces what symptoms?

A

Dysarthria and clumsiness of the hand that is most prominent when the patient is writing

153
Q

What is the MOA and use of Leuprolide?

A

GnRH agonist that eventually reduces GnRH and testosterone/estrogen secretion

Prostate cancer and excessive androgens

154
Q

What are the components of the hyperGLUC mnemonic for the side effects of HCTZ?

A

Hyperglycemia
HyperLipidemia
Hyperuricemia
Hypercalcemia

155
Q

What is the MOA of pilocarpine in the treatment of open angle glaucoma?

A

Muscarinic agonist that causes miosis, and opens canal of schlemm

156
Q

When does neuronal injury occur in status epilepticus?

A

After 30 minutes

157
Q

What is the mortality rate of status epilepticus?

158
Q

True or false: patients in status epilepticus with minimal myoclonic activity are at low risk for neuronal damage

159
Q

What infection is associated with polyarteritis nodosa?

160
Q

What are the s/sx of polyarteritis nodosa?

A

General B symptoms
Skin ulcers
Inflammation of medium sized arteries

161
Q

What is the abx of choice for neisseria gonorrhea?

A

Azithromycin or doxycycline

162
Q

What is the first line treatment for chlamydia?

A

Ceftriaxone

163
Q

What is the pathophysiology and genetic inheritance of familial hypocalciuric, hypercalcemia?

A

AD inappropriate sensing of Ca by receptors in the PTH gland and the kidney

164
Q

What is the screening and confirmatory test for Lyme disease?

A 
Screening = ELISA
Confirmatory = Western blot
165
Q

CNS lymphoma in an HIV patient is strongly associated with what infectious process?

166
Q

What is the treatment for mucormycosis?

167
Q

What is the MOA and use of chlordiazepoxide?

168
Q

What is the definitive treatment for thrombocytopenia in pts 2/2 CLL?

A

Splenectomy

169
Q

What are the two abx of choice for empiric treatment of teenage-adult-elderly meningitis?

A

Vancomycin and ceftriaxone

170
Q

What is the abx that is added to vancomycin in neonatal meningitis to cover listeria?

A

Ampicillin

171
Q

Where in the heart is BNP secreted?

A

Ventricles

172
Q

What is the best imaging technique to evaluate for vesicoureteral reflux?

A

Tch 99 acid renal scan

173
Q

Which type of brain herniation classically leads to respiratory failure?

A

Cerebellar tonsillar herniation into the forman magnum

174
Q

Patients who have been treated for Hodgkin’s lymphoma with alkylating agents are at risk for what hematologic disturbance later in life?

175
Q

What are the antibodies that cause the skin manifestations of celiac disease?

A

IgA towards endomysium

176
Q

What is the treatment for dermatitis herpetiformis associated with celiac disease?

177
Q

CLL, when left untreated, may progress to what?

A

Other lymphomas, most commonly diffuse large B cell lymphoma

178
Q

What part of the middle cerebral artery supplies Wernicke’s area?

A

Inferior division

179
Q

Where are the lesions classically associated with scabies? When is the pruritus the worst?

A 
Intertriginous areas (e.g. between toes, axillae, panniculus, etc)
At night
180
Q

What is the treatment for nephrogenic DI? MOA?

A

Amiloride

Prevents accumulation of Li in the collecting duct cells by blocking the epithelial Na channels in the luminal membrane through which Li enters

181
Q

What may appear on PBS of ITP?

A

Megathrombocytes

182
Q

When is pharmacologic therapy indicated in children with ITP? What is the treatment?

A

If platelets are less than 30,000 and mucosal bleeding

IVIG

183
Q

What part of vision is lost first with glaucoma: peripheral or central?

A

Peripheral

184
Q

What is the treatment for open angled glaucoma? How does this work?

A
  • Latanoprost

- Prostaglandin increases uveoscleral outflow of aqueous humor, thereby lowering IOP.

185
Q

What is the role of beta blockers like timolol in the treatment of open angle glaucoma?

A

No longer used as prostaglandins are more efficacious, but used to be used to decrease production of aqueous humor

186
Q

What happens to EF with dilated cardiomyopathy?

187
Q

What is the treatment for dilated cardiomyopathy? (3)

A

ACEIs
Diuretics
Beta blockers

188
Q

What is a major complication of diabetic nephropathy?

A

Coagulation of the renal vein, and subsequent ischemia/infarction

189
Q

What is the treatment for renal vein thrombosis 2/2 diabetic nephropathy?

190
Q

What is the typical presentation of renal vein thrombosis 2/2 DM nephropathy?

A

Severe onset of flank pain, with hematuria, and proteinuria

191
Q

Why should patients with electrical burns not be given Dextrose solutions?

A

Burns already lead to hyperglycemia from stress response

192
Q

What is the first step in monitoring patients with severe electrical burns (Besides ABCs)?

A

Cardiac monitoring and Troponin

193
Q

What causes hexagonal renal stones?

A

Cystinuria

194
Q

What is the common adverse rxn to cyclosporine?

195
Q

What is the MOA of cyclosporin?

A

Calcineurin inhibitor (prevents IL-2 transcription)

196
Q

What syndrome is characterized by diffuse telangiectasias, AV malformations, and aneurysms? What is its inheritance pattern?

A

Osler-Weber-Rendu syndrome

AD

197
Q

What primary CNS tumor is associated with tuberous sclerosis?

A

Astrocytoma

198
Q

Adenocarcinoma that arises from the anterior superior dome of the bladder is caused by what?

A

Urachal CA

A1 (32 decks)

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