uworld11

Question 1

what should you do if you find a pulm nodule- high malignancy risk vs low malignancy risk

Answer 1

high- resection

low-int: based on nodule size:
<8mm: serial CT
>8mm: PET –> resect

Question 2

what makes a pulm nodule high risk for malignancy

Answer 2

nodule>2 cm and irregular
age >60
smoking

Question 3

what is strongest predictor of stent thrombosis within first 12 months of stent placement?

Answer 3

premature dicontinuation of antiplatelet therapy

Question 4

what to use for cancer staging

Answer 4

CT

Question 5

how can a massive PE cause increased JVP?

Answer 5

inc pulm vascular resistance –> RV pressure increases –> Right sided heart failure

Question 6

elevated retic count
increased LDH
decreased haptoglobin

Answer 6

intravascular hemolytic anemia

Question 7

most common causes of secondary digital clubbing

Answer 7

lung malignancies, CF, right to left shunt

Question 8

what is digital clubbing

Answer 8

enlargement and broadening of fingertips

d.t connective tissue prolif at nail bed and distal phalanyx

Question 9

most common cause of AS in patient under 70

Answer 9

bicuspid aortic valve

Question 10

what should you htink of when:

osteolytic lesions, recurrent infections, const. sympt

Answer 10

multiple myeloma

Question 11

warfarin induced skin necrosis

Answer 11

within first few days of warfarin

in patients with underlying protein c def

Question 12

which heart sound associated with MI

Answer 12

S4

Question 13

should digoxin dose be changed with amiodarone addition

Answer 13

decrease digoxin by 25%-50%

Question 14

how long does b12 vs folate deficiencies take to present?

Answer 14

b12-years

folate- 5-6 weeks

Question 15

what byproducts are up in b12 vs folate deficiencies?

Answer 15

b12:
high homocysteine
high methylmalonic acid

folate:
high homocysteine
nl methylmalonic acid

Question 16

can asthma be diagnosed in adults?

Answer 16

yes

more severe

Question 17

how much does post-bronchdilator FEV1 have to increase to be considered reversible

Answer 17

> 12%

Question 18

what is DLCO in asthma vs COPD

Answer 18

asthma: inc or nl

COPD: dec or nl

Question 19

young pt with chronic dyspnea on exertion and slight liver function test abnormalities with fam hx of cirrhosis should be suspected to have

Answer 19

alpha 1 antitrypsin deficiency

Question 20

hypertrophic osteoarthropathy

Answer 20

clubbing and joint arthropathy

associated with lung cancer

Question 21

what can prolong survival in patients with COPD

Answer 21

long term supp O2

Question 22

criteria for initiating long term supp O2

Answer 22

resting PaO2<55 or SpO2<88%

or PaO2<59 or SpO2<89 in patients with evidence of R HF or hematocrit >55% (secondary polycythemia)

Question 23

what murmur does bacterial endocarditis make

Answer 23

TR

systolic murmur, inc with inspiration

Question 24

what should you do if elderly woman with hx of CV risk factors presents with n/v, epigastric pain

Answer 24

EKG- r/u atypical MI

Question 25

should someone taking INH for TB who develops mild increases in ALT,AST (<100) discontinue the treatment?

Answer 25

no, only discontinue if hepatotoxicity

Question 26

does smoking cessation reduce BP

Answer 26

nah, but encourage it anyway

Question 27

best ways to reduce BP in which order

Answer 27

``` lose weight- DASH diet exercise reduce salt alcohol intake ```

Question 28

drugs associated with acute pancreatitis

Answer 28

``` diuretics anti seizure meds- valproic acid azathioprine HIV meds abx- MTZ, tetracycline ```

Question 29

renal vein thrombosis is a complication with what and associated with what

Answer 29

nephrotic syn membranous glomerupathy

Question 30

what causes widened mediastinum with pleural fluid containing amalyse

Answer 30

boorhaeave syndrome

Question 31

diagnose boorhaave

Answer 31

CT or gastrograffin esophagography

Question 32

most common complication of influenza

Answer 32

secondary bacterial pneumonia

Question 33

what most common cause of secondary bacterial pneumonia in young people

Answer 33

MRSA

Question 34

which masses found in anterior vs middle vs posterior mediastinum

Answer 34

anterior: thymoma middle: bronchogenic cyst posterior: neurogenic tumors, esophageal leiomyomas

Question 35

what constutitues as neurogenic tumor

Answer 35

``` meningocele enteric cysts lymphomas diaphragmatic hernias esophageal tumors aortic aneurysms ```

Question 36

infective endocarditis- most common bacteria on hospital vs community acquired

Answer 36

hospital: staph (aureus, epi) community: strep (viridans, bovis)

Question 37

which infective endo bacterial strain associated with tooth extractions?

Answer 37

strep viridans- specifically S. sanguinis