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BOARDS STEP 2 STUDY MATERIAL > UWorld wrong questions part 2 (2nd 200 q's) > Flashcards

UWorld wrong questions part 2 (2nd 200 q's) Flashcards

1
Q

how to tell apart methanol poisoning and ethylene glycol poisoning?

A

methanol = blurry vision, blindness. Ethylene gycol = kidney damage.

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2
Q

Pericarditis with atypical ECG findings, check what? Tx?

A

BUN/Cr, as this can be uremic pericarditis. Tx with dialysis (NOT NSAIDS)

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3
Q

thunderclap headache worse when lying flat, vision changes, mausea, noncontrast CT with slit=like lateral ventricles and no blood = ? Dx with?

A

idiopathic intracranial HTN, due to impaired CSF absorption/excess production. Dx: LP showing increased ICP.

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4
Q

a) HTN b) amyloid angiopathy c) AV malformation d) venous sinus thrombosis ) berry aneurysm leads to what kind of brain hemorrhage?

A

a) intracerebral b) intracerebral c) both intracerebral and subarachnoid d) intracerebral e) subarachnoid

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5
Q

1 and #2 nonpharm ways to decrease BP?

A

1) weight loss; 2) DASH diet

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6
Q

1st thing to do for a stroke when it has been >4 hrs?

A

ASA; ASA + clopidogrel/dipyrimadole if already on ASA

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7
Q

Person got stabbed, now has BP 170/68, brisk carotid upstroke, systolic murmur, tachy, this is what? Dx?

A

AV fistula.(high output cardiac failure). Dx: doppler U/S

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8
Q

Forgetful old patient with CT showing a) diffuse cortical atrophy greater in temporal/parietal lobes =? b) Areas of hypodensity involving diff brain regions =?

A

a) Alzheimer’s. b) Multi infarct dementia

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9
Q

eye problem where straight lines appear wavy =?

A

macular degeneration (do “grid test” to screen; see drusen deposits on optho exam)

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10
Q

PDE-inhibitors: contraindications? what you can use but need to space >4hrs apart?

A

contra: do not use with nitrates. 4 hrs apart with alpha blocks (-zosin) to prevent hypotension.

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11
Q

How to confirm diagnosis of pericardial effusion?

A

echo

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12
Q

patient has increased glucose – what treatment should you initiate?

A

besides metformin, all patients ages 40-75 should get statin!!

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13
Q

what heart defect is common with Edwards syndrome?

A

VSD

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14
Q

common complication of acute aortic dissection?

A

cardiac tamponade (so, pericardial fluid accumulation)

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15
Q

why is sodium low in CHF?

A

from increased renin, NE, and ADH; so, the lower Na is, the more severe the HF

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16
Q

difference between breathing of croup and bronchiolitis?

A

croup = inspiratory stridor, bronchiolitis = expiratory stridor

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17
Q

how to treat bronchiolitis?

A

O2 and iV; NOT steroids!! not ribavirin!!

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18
Q

how to treat croup?

A

O2, steroids, racemic epi

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19
Q

what meds to withhold prior to cardiac stress testing?(48 hrs)

A

beta blockers, CCBs, nitrates, dipyridamole

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20
Q

what heart meds are contraindicated in restrictive lung disease? obstructive lung disease?

A

restrictive: amiodarone (b/c pulm fibrosis). obstructive: beta blockers

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21
Q

how are cyanotic spells in Tetralogy of Falot decreased(thru what physiologic mechanism)?

A

tet spells (bringing legs up) increases systemic vascular resistance, so there is a bigger difference between ss and pulm vascular resistance and blood is shunted L–>R instead of R–>L

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22
Q

when do you not need to treat a fib w/ RVR with anything?

A

when it is “lone AF” – single time, score 0 (no risk – no CAD or heart issues)

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23
Q

inflammation of all vessels except lung in hep B/C patient, +ESR, increased WBCs?

A

polyarteritis nodosa

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24
Q

decreased pulses in UE of young woman, what is it? Dx with? tx with?

A

Takayasu arteritis. Dx with CT angio/MRA. Tx with steroids, immunosuppressants.

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25
Q

child with recent URI, spots on LEs, arthritis, increased BUN/Cr

A

Henoch Schleinen Purpura (IgA nephropathy)

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26
Q

red eyes, rash on trunk, increased lymphadennopathy, erythema of mucous membrains, fever, edematous hands in kid = ? Tx?

A

Kawasaki (mucocutaneous lymph node syndrome). Tx with IVIG, high dose aspirin, then low dose. do echo. NO steroids

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27
Q

pansystolic murmur at LLSB in neonate = ?

A

VSD

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28
Q

systolic murmur at LLSB with cyanosis = ?

A

truncus arteriosus

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29
Q

loud S2 and cyanosis =? Tx?

A

transposition of great vessels. Tx: keep PDA open with prostaglandin; balloon atrial septrostomy, Sx.

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30
Q

widely split S2, tricuspid regurgitation, dilated right atrium =? leads to what? dilated RA causes what? Tx?

A

Ebstein anomaly (tricuspid leaflets displaced into right ventricle so it becomes hypoplastic; SVT and WPW common with dilated RA. Tx: PGE, digoxin, diresis, propanolol for SVT

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31
Q

newborn with signs of LHF and ECG interpreted as L sided MI = ?

A

anomalous pulm venous return (pulm veins go to R instead of L)

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32
Q

tetralogy of Fallot treatment?

A

PGE2, O2, IVF, BB

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33
Q

most common microbe for pneumonia in a) COPD pt? b) rust colored sputum? c) after flu infection d)with vent?

A

a) H flu b) Strep pneumo c) Staph aureus d) Pseudomonas

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34
Q

who should get pneumococcal vaccine?

A

all smokers ages 19/54, all ppl ages 65+, immunocomp and chronic disease ppl

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35
Q

What is CENTOR criteria for pharyngitis?

A

Points to bacterial cause if numbers are high: Cough (absence of), Exudates, Nodes, Temp, OR age (young). 0-1 points = do nothing. 2-3 points = culture, 4-5 points = treat.

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36
Q

what are the 4 indicators for home O2?

A

pulse Ox

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37
Q

what to do about pulm nodule found on CXR after checking old one?

A

do CT; if benign looking (

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38
Q

idiopathic pulm fibrosis - Tx?

A

pirfenidone, nintedanib

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39
Q

increased risk of TB with which restrictive lung disease?

A

sarcoidosis

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40
Q

How to treat a)Goodpasture syndrome? b) Granulomatosis with Polyangitis (Wegeners)?

A

a) plasmapheresis, steroids. b) cyclophosphamide, steroids

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41
Q

How to treat pulmonary edema?

A

“NO LIP” = nitrates, O2, loop diuretics, inotropic drugs, positioning

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42
Q

treatment for croup?

A

humidified O2, dexamethasone/prednisolone, racemic epi

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43
Q

how to treat pulm component of CF?

A

beta agonist, DNase I(dornase alpha), hypertonic saline, physiotherapy, azithro to prevent Pseudomonas

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44
Q

What is the only bacterial diarrhea that you treat with drug (besides C difficile) and with what?

A

Shigella: FQ or TMP-SMX

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45
Q

what diarrhea mimics appendicitis (RLQ pain).

A

Yersinia

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46
Q

bloody diarrhea with liver abscess = ? Tx?

A

E. HISTOLYTICA. Tx: metro.

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47
Q

periorbital edema + diarrhea, fever, myalgias, CNS/cardiac probs = ? Tx?

A

Trichinella. Tx: -bendazole

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48
Q

How to treat Taenia solium?

A

praziquantel if in GI, steroids + albendazole if in CNS

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49
Q

PE with hemoptysis and pleuritic pain = ?

A

b/c of occlusion of a pulmonary artery by thrombus –> pulmonary infarction

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50
Q

what is usually high starting out on vent setting that should be lowered after initial intubation?

A

FiO2 – lower to under 60% to prevent O2 toxicity (but do not increase above this if you need to improve O2 – in those cases, increase PEEP)

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51
Q

what two conditions both have decreased O2 and decreased CO2, and resp alkalosis?

A

ARDS, CHF exacerbation (b/c of tachypnea)

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52
Q

how to tell diff between pneumonia and PE when both show exudative effusion?

A

pH is acidic in pneumonia (&TB & cancer etc) while pH is normal in PE

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53
Q

what numbers on the vent relate to CO2? which should you modify to change the CO2?

A

Tv and RR. Change RR

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54
Q

suspect pneumonia, what is the first step in management?

A

CXR (NOT sputum stain – this is s low and optional b/c you can just give empiric Abx)

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55
Q

definitive diagnosis of sarcoidosis with what?

A

mediastinoscopy/bronchoscopy for tissue Bx (NOT ACE/Ca levels)

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56
Q

diff between pneumonia and pleural effusion?

A

pneumonia will have increased fremitus(sound conducts well through solid), effusion will have decreased fremitus

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57
Q

low back pain esp at night in young adult that improves with exercise but not at rest = ? what eye and lung probs does it also have?

A

ankylosing spondylitis. with anterior uveitis, restrictive lung disease from chest wall motion restriction

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58
Q

what pneumonia presents with hyponatremia and gram strain with many neutrophils but no organisms? How to treat?

A

Legionella. Tx: fluoroquinolones or new macrolides.

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59
Q

what is upper airway cough syndrome and how is it treated?

A

post-nasal drip – treated with H1 antagonist like chlorpheniramine

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60
Q

calcified lesion above sella = ?

A

craniopharyngioma

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61
Q

how to treat hep encephalopathy?

A

lactulose or rifaximin (Abx)

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62
Q

asciites + fever and increased WBCs in it, what is this? How to treat?

A

Spontaneous bacterial peritonitis. Tx: cefotaxime or ceftriaxone, albumin

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63
Q

How to treat portal HTN?

A

salt restrict, spironolactone + furosemide, beta blockers for varices, vasopressin if varices are bleeding, TIPD procedure

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64
Q

hypocalcemia - what is next step, then 3rd step?

A

1) measure PTH 2) measure vit D

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65
Q

NPH - how to diagnose? Tx?

A

Dx: enlarged ventricles on MRI/CT + normal P on LP. Tx: sequential CSF removal with serial LPs, then VP shunt

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66
Q

why should you not give beta blockers right away in pheochromocytoma?

A

will cause rapid increase in BP (so, give alpha blocker 1st)

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67
Q

How to treat TCA O.D.?

A

NaHCO3 for the QRS widening/ventricular arrhythmias, benzo for sezure, IVF, O2, intub. charcoal if within 2 hrs of ingestion

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68
Q

after suspecting Guillian-Barre (CSF shows protein, no organisms), what is next step in management?

A

spirometry to measure FVC, b/c NM respiratory failure is biggest complication of the disease). If FVC is declining, intubate.

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69
Q

side effect risk of radioactive I2 ablation?

A

hypothyroidism, worsening of eye bulging (of Graves)

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70
Q

side effect of PTU & methimazole

A

agranulocytosis. PTU: hepatic failure.

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71
Q

treatment for Alzheimer’s

A

ChE inhibitors: donepezil, memantine (mod–>severe), galantamine, rivastigmine. NOT amantadine (this is for Parkinson’s!)

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72
Q

Marfanoid body habitus + stroke-like sx & fair eyes/hair, developmental delay = ? Tx?

A

Homocystinuria (stroke is due to hypercoagulability). Tx: B6, folate, B12 to lower homocysteine. Anticoag/antiplatelets.

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73
Q

what is livedo reticularis (lacy red areas that blanch) + blue toes, ulcers found in ?

A

cholesterol emboli (can be from recent cardiac cath or other procedure)

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74
Q

how to treat febrile seizure?

A

If 1st time and 5 min, abortive therapy i.e. benzos.

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75
Q

what is number 1 risk factor for pancreatic cancer?

A

smoking (NOT alcohol; that is for chronic pancreatitis)

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76
Q

liver problems(cirrhosis), hypotension, and increased Cr which doesn’t change with IVF admin, think ..=? Tx?

A

hepatorenal syndrome. Tx: liver transplant

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77
Q

after NG tube is put in to determine upper GI bleed, what is next step in management?

A

endoscopy

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78
Q

what to do for tension pneumothorax? for other __-thoraxes?

A

tension: needle thoracostomy. All others: chest tube

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79
Q

diagnostic test for pancreatic cancer?

A

abd CT (do after abd U/S for jaundice)

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80
Q

decreased lung compliance found in…

A

restrictive lung diseases

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81
Q

digital clubbing is a sign of what?

A

lung malignancy, CF, or R to L cardiac shunt

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82
Q

how to treat MALT lymphoma?

A

triple therapy for H. pylori (b/c this is cause!)

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83
Q

Cryptosporidium causes diarrhea in HIV patients under what CD4 count?

A

180

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84
Q

where is Zinc digested? sx of deficiency?

A

in the jejunum (so bowel resection will decrease this; it is not included in TPN formula). Alopecia, abnormal taste, rash, impaird wound healing.

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85
Q

main problem with selenium deficiency?

A

cardiomyopathy (Se is not in TPN)

86
Q

patient with cirrhosis, saw liver on abd U/S – what are next steps in management?

A

if liver mass that looks like HCC, do CT. if no mass, then next is endoscopy to look for varices (if yes, beta blockers, EGD yearly); then abd U/S every 6 months

87
Q

CO2 and O2 in people with OSA?

A

increased CO2, decreased O2, because of hypoventilation. resp acidosis, so kidneys compensate by retaining HCO3

88
Q

MoA of exudative pleural effusion?

A

increased capillary permeability (because this is what allows proteins to get thru)

89
Q

suspect PE - what to do next?

A

if unlikely (low Wells criteria), do D-dimer to exclude PE. If likely, go SRAIGHT to CT angio

90
Q

diff btwn Sx of GERD and diffuse esophageal spasm? next steps in management?

A

GERD: burning discomfort. 1st step= empiric PPI trial.(NOT 24 hr pH) DES: pain precipitated by emotional stress radiating to the back. Manometry.

91
Q

main s.e. of KCl?

A

drug-induced esophagitis

92
Q

impaired O2 gas exchange, decreased lung compliance, and pumonary HTN lead to what?

A

ARDS

93
Q

Face and arm swelling, dyspnea, engorged veins = ? Cause? Dx?

A

SVC syndrome. Caused by malignancy, so watch out for cancer signs. Dx: CXR.

94
Q

elderly person with iron def anemia – first step? second step?

A

fecal occult blood. 2nd step(definitive diagnosis) = colonoscopy and endoscopy EVEN IF FOBT is (-)!

95
Q

patient uses NSAIDS and aspirin, think what kind of anemia?

A

Iron-deficiency anemia (because it causes ulcers, which impairs absorption at duodenum)

96
Q

Dx? treatment for achalasia?

A

Dx with manomtry, Barium, and r/o malignancy with EGD. Tx: SURGICAL: pneumatic dilation, myotomy, Botox,

97
Q

how to treat Diffuse esophageal spasm?

A

MEDICAL: CCBs ie nifedepine, TCAs, nitrates

98
Q

how to diagnose Zenker diverticulum?

A

Barium shows outpouching (DO NOT do EGD - can perforate.

99
Q

patient with dysphagia – 1st step in management?

A

Barium swallow (THEN EGD and manometry if NM suspected)

100
Q

How to diagnose PUD? Tx?

A

EGD; urea breath/serum Abs/stool Ag to see if H pylori; gastrin then secretin test if refractory to look for ZE. Tx: triple therapy if H pylori, sucralfate, bismuth, misprostol or COX-2 inhibitors if NSAID-caused ulcer

101
Q

How to Dx and Tx Z-E syndrome?

A

Dx: fasting gastrin, secretin stimulation, and CT/MRI OR endoscopic U/S OR somatostatin-R scintigraphy to look for tumor. Tx: resection, PPI.

102
Q

what does (abn) Sudan stain mean? (abn) D-xylose? What does it mean for lactose intolerance?

A

Sudan: problem absorbing fat. D-xylose: problem absorbing carbs. so lactose intolerance has normal Sudan, abnormal D-xylose

103
Q

How to Dx, Tx Whipple Dz?

A

Dx: jejunal Bx: foamy macrophages on PAS, villous atrophy. Tx: IV ceftriaxone & TMP-SMX

104
Q

what to do for acute diarrhea (

A

If no fever, blood, less than 5 days –> IVF. If fever, blood, more than 5 days do stool cultures, acid fast, fecal WBCs, ova/parasites

105
Q

what to do for chronic diarrhea (>14)

A

fecal occullt blood, CBC, CMP, lactose restriction, D-xylose, Sudan, stool lytes, and eventually colonoscopy

106
Q

how to calculate stool osmolar gap? what numbers mean what?

A

290 - 2(Na + K). if 125, osmotic (gets pulled with solute i.e. celiac, lactose)

107
Q

IBS criteria

A

Sx for at least 3 days per month in the past 3 months

108
Q

ASCA is positive with whar IBD? pANCA positive with what IBD?

A

ASCA: Crohns. pANCA: U.C.

109
Q

Tx for SBO?

A

NPO, IVF, Foley, NG tube, repeat CTs. Sx (laparotomy) if no improvement in 12-24 h, complete SBO, or strangulation

110
Q

Tx for LBO?

A

NPO, IVF, colonoscopy, surgery

111
Q

appendicitis – when to do what?

A

if Sx 5 days Abx, IVF, bowel rest, then appendectomy 8 weeks later

112
Q

Tx of sigmoid volvulus?

A

sigmoidoscopy/colonoscopy for decompression; resection if gangrenous. Add mesosigmoidopexy, resection with primary anastomosis, or Hartmann’s procedure to prevent recurrence.

113
Q

How to Tx anal fissure?

A

topical nitroglycerin, diltiazem/nifedipine, bethanechol. Botox

114
Q

Main treatment of carcinoid syndrome?

A

octreotide

115
Q

f/u for patient who had colorectal cancer ?

A

CEA every 3 months for 3 years, CT chest/abd/pelvis every year (mets), colonoscopy at 1, 3, and every 5 years

116
Q

1st step, then 2nd step in patient with hematemesis/melena?

A

1st: NG tube (likely upper). 2nd: EGD if stable, IVF/transfusions if not.

117
Q

1st step, then 2nd step in patient with hematochezia?

A

1st: NG tube (rule out fast upper), colonoscopy if stable, IVF/transfusions if not

118
Q

what is SAAG?

A

serum albumin - asciites albumin. if >1.1, portal HTN is cause. if

119
Q

Tx for spontaneous bacterial peritonitis?

A

cefotaxime or ceftriaxone

120
Q

what are reportable diseases?

A

STDS, hep, Lyme, food-borne illnesses, meningitis, rabies, TB

121
Q

hypoglycemia, increased C-peptide, tumor in pancreas on CT = ? Tx?

A

insulinoma. Tx: resection, diazocide, octreotide

122
Q

swollen, painful vessels popping up in random areas throughout the body = sign for what?

A

pancreatic adenocarcinoma (this is Trousseau syndrome, aka migratory thrombophlebitis)

123
Q

best way to diagnose kidney stones?

A

noncontrast CT abd/pelvis (because plain film/KUB won’t show uric acid stones, which are radioluscent)

124
Q

treatment for glucagonoma?

A

surgical resection, octreotide, IFN-alpha, embolization

125
Q

patient with RUQ pain, jaundice, fever, AMS, and low BP – what is this? Tx?

A

Reynold’s pentad – primary sclerosing cholangitis. Tx: IVF, IV ABx, endoscopic biliary drainage, DELAYED cholecystectomy

126
Q

diff btwn treatment for cholecytitis and cholangitis?

A

Cholecystitis: cholecystectomy. Cholangitis: drain bile ducts with ERCP, IVF & Abx, then delayedcholecystectomy.

127
Q

what is Ab for primary biliary cirrhosis? primary sclerosing cholangitis?

A

PBC: AMA, ANA……PSC: p-ANCA

128
Q

Tx for Crigler-Najjar syndrome type 1? type 2?

A

1: phototherapy, plasmapheresis, liver transplant. 2: phenobarbital.

129
Q

patient with acute RUQ pan and hepatomegaly, and rapid development of jaundice and asciites, think… ? Initial Dx? Gold standard? Tx?

A

Budd Chiari syndrome. Initial: U/S(shows hepatic vein thrombosis). Gold: hepatic venography. Tx: thrombolytics, diuretics, anticoag, angioplasty, shunt.

130
Q

treatment for Wilson disease?

A

trientine, penicillamine, Zn and B6 supplements. Eventual liver transplant.

131
Q

autoimmune hepatitis – two Ab’s? Tx?

A

anti-SM, anti-Liver-Kidney-Microsomal. Tx: glucocorticoids +/- azathioprine

132
Q

Other conditions/symptoms associated with HCC?

A

decreased glucose, increased EPO, watery diarrhea, increased Ca, skin lesions

133
Q

increased hematocrit in what?

A

Potentially Really High Hematocrit: Pheochromo, RCC, HCC, Hemangioblastoma

134
Q

Dx of pyloric stenosis with what 2 things?

A

Barium swallow: string sign. U/S: pyloric muscle thickness

135
Q

How to Tx necrotizing enterocolitis?

A

TPN, IV Abx, NG suction, surgical resection of affected bowel (if necrosis)

136
Q

Intussusception - Dx? Tx?

A

Dx: barium enema. Tx: Barium enema (reduces defect), Sx if refractory

137
Q

what Abx is contraindicated in neonates with increased bili?

A

ceftriaxone

138
Q

How to treat renal stone (Ca) less than 1 cm? When to do Sx?

A

strain urine with strainer, bring stones, tamsulosin, nifedepine, NSAIDS for pain. Do Sx if unable to pass after 4-6 wks, complete obstruction, persistent infection, or impairment of renal function

139
Q

How to Tx stones in renal pelvis/upper ureter? In rest of ureter? How to Tx staghorn calculi?

A

Pelvis: Extracorporeal shock wave lithotripsy. Ureter: ureterorenoscopy with poss lithotripsy & possible stent placement. Staghorn calculi: percutaneous nephrostolithotomy.

140
Q

incidence – formula? prevalence – formula?

A

Incidence = # of new case / total pop. ——- Prevalence = # new + old cases / total pop

141
Q

relative risk =?

A

probabilitiy of getting a disease in group exposed / probability of getting that disease in unexposed. ——- HORIZONTAL —– A/(A+B) / C/(C+D). —— R>1 = positive relationship (thing causes the disease), R

142
Q

relative risk relates to what kind of study? odds ratio relates to what study?

A

relative risk = cohort study.—— Odds ratio = case control (retrospective)

143
Q

odds ratio = ?

A

VERTICAL — (A/C) / (B/D)

144
Q

when does relative risk become similar to odds ratio?

A

with low prevalence

145
Q

what is a type I error?

A

null hypothesis rejected even though it is true (study showing effect that isnt actually true)

146
Q

what is a type II error?

A

null hypothesis not rejected but should be (showing no effect where there actually is one)

147
Q

confidence interval = ?

A

mean +/- Z x Standard Error of Mean. If 99%, Z=2.6, If 95% Z=2. If 90% Z=1.6.

148
Q

what is attributable risk?

A

rate of disease in exposed = rate of disease in unexposed. A/(A+B) - C/(C+D

149
Q

what is sensitivity? specificity?

A

Sens: prob that screening test will be (+) in patients with disease (disease in denominator): A/(A+C) ————- Spec: prob that screening test will be (-) in patients without the disease (disease in denominator): D / (D+B)

150
Q

What is PPV? NPV?

A

test result in denominator PPV = A/(A+B), probability that patient who tested (+) actually had the disease.———— NPV = D/(C+D), prob that (-) test shows ppl who don;t have disease

151
Q

what is accuracy?

A

[true (+) + true (-)] / everything

152
Q

what is positive likelihood ratio?

A

PLR = sensitivity / 1-spec OR sens / false (+) rate

153
Q

what is the relationship between prevalence and predictive value?

A

high prevalence means high PPV, low NPV

154
Q

persistent hematuria, three causes to think of?

A

APKD, neoplasm, glomerular disease

155
Q

male child with daytime incontinence or UTI or oliguria, distended bladder = next step in management? Tx?

A

Dx: voiding cystourethrogram (VCUG) to look for posterior urethral valve. Tx: FOle or vesicostomy

156
Q

If you need meds for child with daytime incontinence, what do you use?

A

DDAVP (desmopressin)

157
Q

In gallbladder issues, when is HIDA scan used? ERCP? Abd CT? Perc transhep gallbladder drainage?

A

HIDA: when abd U/S is not clear. ERCP: with stones in ducts (choledoco); then do sphincterotomy. Per transhep: to decompress gallbladder if patient is unstable or has contraindication to surgery.

158
Q

what drug causes CNS stimulation (headache, insomnia, seizures), GI (N/V), and arrythmias?

A

theophylline tox, esp when used with other drugs

159
Q

someone sustains blunt abd trauma, what is next step after IVF? Next step after this?

A

assess for intraperitoneal free fluid with bedside U/S = FAST exam (Focused Assessment with Sonography for Trauma). Next step: DPL if study is limited; if either are (-) do abd CT, if either are (+) do exp lap

160
Q

patient with asthma with very high WBCs and neutrophils – why?

A

from glucocorticoid induced neutrophilia

161
Q

diff btwn bronchitis and bronchiectasis Sx? How to Dx bronchiectasis?

A

bronchitis: nonpurulent sputum.
bronchiectasis: purulent, copious sputum, hemoptysis, recurrent infections with Pseudomonas, linear atelectasis on CXR. Dx: high-res chest CT; THEN bronchoscopy/sputum analysis.

162
Q

STEPWISE Tx FOR ASCIITES: (4)

A
  1. Na and H2O restriction / 2. spirinolactone // 3. loop diuretic (not more than 1L/day / 4. abd paracentesis
163
Q

4 main things that cause normal anion gap metabolic acidosis?

A

diarrhea, renal tubular acidosis, TPN, and hypoaldosteronism

164
Q

patient with hyponatremia – what is next step? 2nd step? 3rd step.

A

Check serum osm. If high, it is either hyperglycemia or mannitol. If normal, it is hyperlipidemia or mult myeloma. If low, NEXT STEP = check urine sodium, then volume status.

165
Q

Treatment of central DI? nephrogenic DI?

A

central: Desmopressin. Nephrogenic: salt restrict, increase H2O, thiazides, indomethacin. If lithium-induced, Amiloride.

166
Q

Treatment for hyperkalemia?

A

C BIG K Drop: Calcium gluconate –> B-agonist, insulin + glucose –> kayexalate, dialysis

167
Q

low urine calcium, high serum Ca, but no stones/bones/moans = ?

A

familiar hypocalcuric hypercalcemia

168
Q

QT prolongation in what electrolyte abnormality?

A

hypocalcemia

169
Q

what drug treats glaucoma, idiopathic intracranial HTN, alt sickness(resp alkalosis), met alkalosis? s.e.?

A

acetazolamide. S.E.: metabolic acidosis, hypokalemia, nephrolithiasis, sulfa rxn

170
Q

what treats AKI, acute angle glosure glaucoma, increased ICP? s.e.?

A

mannitol. S.E.: hypernatremia, hyperosmolarity, pulm edema

171
Q

what treats hypercalcemia, periph AND pulm edema, asciites? Contraindications? s.e.?

A

Loops (tosemide, bumetanide,etc). Contra: stones/hypercalcURIA). s.e. hypocalcemia, increased uric acid, hyperkalemia, ototoxicity

172
Q

what diuretic treats hypercalciuria, nephrogenic DI? s.e.?

A

thiazides (chlorthalidone, metolazone, HCTZ). s.e.: hypokalemia, hyponatremia, hyperuricemia, hypercalcemia

173
Q

what drugs treat PCOS, acne, portal HTN, and good for post-MI?

A

ald antagonists (spironolactone: PCOS, acne; eplenerone: everything else).

174
Q

what are amiloride, triamterene?

A

K+ sparing diuretics (not ald antagonists)

175
Q

next step in evaluating hematuria in woman? next step? 3rd step? Management?

A

1) U/A with straight cath (r/o vaginal bleed) 2) CT abd/pelvis (no contrast) r/o renal stone. 3) CT abd/pelvis WITH contrast and post-CT plain film KUB to view radiopaque stones/neoplasm. ——— after all this, if neg, manage by treatming as UTI

176
Q

If you suspect bladder cancer in patient, what is next step?

A

send urine for cytology and perform cystoscopy

177
Q

CV issues with APCKD? Tx?

A

berry aneurysms –> SAH, AND MVP/ Tx: vasopressin-R antagonists (-vaptan), amiloride, drain large cysts.

178
Q

RCC: #1 risk factor? CT shows? Lab shows? Dx?

A

smoking. CT: SOLID (not cystic) renal mass. Labs: increased EPO. Dx: is also the Tx – nephrectomy (DO NOT BIOPSY)

179
Q

someone taking Abx/NSAIDS, gets rash, fever, increased Cr, eosinophilia, U/A showing granular casts and eosinophils = ? Tx?

A

acute interstitial nephritis/interstitial nephropathy. Tx: stop drug; steroids.

180
Q

Someone with protein in U/A, what is next step?

A

24 hour urine

181
Q

How to Tx post-inf glomerulonepritis? Bx shows what?

A

steroids, ACE-i, statins. Bx: subepithelial hymps (granular IgG), many neutrophils.

182
Q

Tx of Goodpasture Syndrome?

A

plasmapheresis, steroids

183
Q

increased Cr, splitting of basement membrane, high frequency hearing loss, cataracts?

A

Alport Syndrome

184
Q

4 types of RPGN, What is common feature

A

common: a type of nephritic syndrome + crescents in glomerulus & lead rapidly to RF. Type I: anti-GBM Ab(Goodpasture). Type II: immune complexes (i.e. IgA neph, lupus). Type III: pauci immune, p-ANCA, type IV: idiopathic.

185
Q

lupus nephritis – Tx?

A

Tx: steroids, ACE-i, statin

186
Q

most common nephrotic syndrome? What do you see in glomeruli? what comorbid Dz?

A

FSGS. Glomeruli: scerosis & hyalinosis in

187
Q

spike and dome appearance/thickening of BM = ? comorbid Dz? Tx?

A

membranous (“member” = thickened) nephropathy. Dz: hep B. Tx: steroids, ACE-i, statins

188
Q

splitting of/”double” BM aka tram-track appareance with subendothelial humps= ? what comorbid Dz?

A

MPGN (“proliferating”, so double BM) Dz: Hep C>B (longer name than memb nephropathy so later in alphabet).

189
Q

thickened BM + mesangial expansion, nodules = ?

A

diabetic nephropathy

190
Q

what do hyaline casts mean? WBC casts? epithelial cast? granular/muddy brown casts?

A

hyaline: no disase (concentrated urine). WBC: tubular interstitial disease, pyelo. epithelial: glomerulonephritis. Gran/mud: acute tubular necrosis (ethylene glycol, drugs, etc)

191
Q

if FENa 2%?

A

2% intra or post.

192
Q

FENa formula?

A

[urine Na/serum Na] / [urine Cr/serum Cr]

193
Q

Labs = increased K, decreased Na, increased PO4, decreased Ca, anemia, increased BUN/Cr, urine Osm close to serum Osm, what is this?

A

CKD

194
Q

indicators for dialysis?

A

very high K+, met acidosis, uremia, Cr >12, BUN >100, fluid overload, severe O.D.

195
Q

what else is urease (+) aside from Proteus?

A

Klebsiella (so, can cause struvite stones)

196
Q

most common bacteria from indwelling cath?

A

Pseudomonas

197
Q

gold standard diagnosis for UTI? for pyelonephritis also do what?

A

UTI: Urine culture. Pyelo, add blood culture.

198
Q

empiric Tx for pneumonia in 2 month old? 2 year old?

A

2 month: macrolide + cefotaxime. 2 year: amp/amoxicillin

199
Q

what 4 drugs can you use to Tx UTI in pregnant woman?

A

amoxicillin, ampillicin, cephalosporin, nitrofurantoin

200
Q

Tx for urge incontinence? Stress incontinence? Overflow?

A

Urge: anticholinergics (oxybutynin, tolterodine), imipramine.

  • —– Stress: Kegels, weight loss, imipramine, mid urethral sling surgery.
  • —–Overflow: decompression of bladder with cath, long term self cath.
201
Q

how to Dx overflow incontinence?

A

U/S or cath post-void shows full bladder

202
Q

what is transitional cell bladder cancer usually from? squamous? adeno? Tx?

A

transitional: tobacco. Squamous: schistosoma. Adeno: urachal remnants. Tx: transurethral cystoscopic resection of tumor, THEN radical cystectomy + urinary diversion if progresses.

203
Q

next step in management of urethritis or prostatitis in man

A

gram stain (if (-) diplo, then Gonorrhea. if nothing, then do DNA amplification to look for Chlamydia)

204
Q

Dx of prostate cancer – 1st, 2nd, 3rd step? Tx?

A

1st: DRE (but may be normal); 2nd: PSA, alk phos. 3rd: transrectal U/S with Bx.——-Tx: radical prostatectomy if life expectancy high enough; may need antiandrogen/continuous GnRH analog(- effect) for chemical castration of advanced/met disease.

205
Q

two disease to think of with painful testicle?

A

testicular torsion (no cremasteric reflex, compromised blood flow on U/S, raised testicle, support doesn’t help pain) OR epididymitis (infection/STD signs, support helps pain, normal blood flow and reflexes)

206
Q

right sided varicocele: sign of what disease? Varicocele Dx?

A

RCC (because reg varicoceles are L»R). Dx: color doppler U/S showing retrograde flow to scrotum

207
Q

Dx of testicular Ca (2 steps)? Tx(2 steps)?

A

Dx: scrotal U/S, CT abd/pelvis for mets. ——Tx: radical orchiectomy, followed by chemo for seminoma (b-hcg) / retroperitoneal lymph node dissection for nonseminoma

208
Q

primary testicular failure in male infertility is indicated by what lab finding? Tx?

A

FSH. —Tx: surg, hormones but NOT exogenous testosterone.

209
Q

increased prolactin in man. Next step in management?

A

MRI of head

210
Q

Tx for epididymitis if 35?

A

35: FQ or TMP-SMX

211
Q

workup for ED - 4 labs

A

total T, prolactin, TSH, PSA

BOARDS STEP 2 STUDY MATERIAL (6 decks)

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