Uworld2 Flashcards
who gets endoscopy with GERD
over age 50 with chronic symptoms and cancer risk factors (tobacco use).
What type of bilirubin is increased in Gilbert disease
unconjugated
Drug choice of hepatic encephalopathy
1st: lactulose and rifaximin
2nd: Neomycin
what are 2 markers to use for diagnostic tests for acue hepatitis B
HBsAg
Anti-HBc (will remain elevated during window period)
Lamivudine
treats HIV and chronic HBV cofinfection
What is elevated in rotor syndrome
conjugated hyperbilirubinemia
positive urine bilirubin assay reflects?
build-up of conjugated bilirubin
Positive urine urobilinogen reflects?
unconjugated bilirubin excess
Caseating vs. non caseating granulomas
Caseating: TB
noncaseating: crohns, sarcoidosis
Treatment for toxic megacolon
conservative management and steroids (if IBD associated)
what is seen on biopsy for ulcerative colitis
Mucosal & submucosal inflammation
crypt abscesses
colonoscopy screening for UC patients
begin 8 hours after the initial diagnosis and repeat every 1-2 years
Via lab values how do you tell the difference between ischemic hepatic injury and acute Hep A/B
both have extremely elevated AST/ALT
Hep A/B will also have elevated hyperbilirubinemia. this will be normal in ischemic hepatic injury
associated neoplasm with Lynch syndrome
Colorectal
endometrial
ovarian cancer
MEN1
Parathyroid adenoma
Pituitary adenomas
Pancreatic adenomas
MEN2
Medullary thyroid
Pheochromocytoma
Parathyroid hyperplasis (2A)
bowel sounds during opioid withdrawal
increased bowel sounds
What does this patient most likely have?
abdominal pain, microcytic anemia, positive fecal occult blood, and hepatomegaly with a hard edge on liver palpation
GI malignancy with mets to liver
Isoniazid can cause what vitamin deficiency?
Niacin
Most common patients to get nonalcohlic fatty liver disease
Diabetics and obese patients
Painless jaundice in a patient with conjugated hyperbilirubinemia and markedly elevated alkaline phosphatase should raise concern for what?
- biliary obstruction due to pancreatic or biliary cancer
- choledocholithiasis
- benign biliary stricutre.
how does cocaine cause peptic ulcer disease
vasoconstriction
how does aspirin and alcohol cause peptic ulcer disease
direct mucosal injury
calcified rim in the gallbladd wall with a central bile-filled dark area is associated with? next step?
gallbladder adenocarcinoma
cholecystectomy
Characterize primary biliary cholangitis
destruction of intrahepatic bile ducts
Name 2 associated complications for primary biliary cholangitis
Osteoprosis/osteomalacia
Xanthelasmas
Next step in management for psoas abscess
CT to confirm diagnosis`
Which hereditary liver problem is associaed with UC
Primary sclerosing cholangitis
Refeeding syndrome
rapid electrolyte shifts when nutrition is reintroduced to malnourished patients
What is automotive antifreeze? what does it do in the body
ethylene glycol poisoning
Calcium oxalate crystals
Whipple disease
arthralgias weight loss fever diarrhea abdominal pain PAS positive material in lamina propria of small intestines
difference between tropical sprue and whipple disease
tropical sprue –> paitient should have lived in a tropical area for more than one month.
3 main categories of symtpoms for wilson’s disease
hepatic
neurologic
psychiatric
some characteristics of zinc deficency
alopecia pustular skin rash hypogonadism impaired wound healing impaired taste immune dysfunction
what will endoscopy show for Zollinger Ellison syndrome
thickened gastric folds
multiple stomach ulcers
In Zollinger Ellison syndrome, which one happens? Inactivation of pancreatic enzymes or pancreatic exocrine deficiency?
Inactivation of pancreatic enyzmes by increased production of stomach acid may lead to malabsorption
FSH and LH levels in anabolic steroid use?
low
FSH and LH levels in Klinefelter syndrome
high
What is the preferred initial treatment for uncomplicated benign prostatic hyperplasia? what medication can be added?
alpha-1-blockers (Terazosin & Tamsulosin)
5-alpha-reductase inhibitors (finasteride)
Side effects of terazosin and tamsulosin
orthostatic hypotension, dizziness
contraindications for phosphodiesterase-5 inhibitors
nitrates and alpha blockers
Second line treatment for erectile dysfunction
alprostadil (prostaglandin E1) –> induces vasodilation
Via what lymph node does testicular cancer spread
retroperitoneal lymph
triad for renal cell carcinoma
hematuria
flank pain
palpable abdominal mass
Leydig cell tumors
increase estrogen production
Yolk sac
increase serum AFP
What is the most common etiology for acute bronchitis
viral respiratory illness
acute heart failure and Co2 levels
hypocapnia and respiratory alkalosis
On the Vent, what value should FiO2 be at
less than 60%
On the vent, how do you change O2
FiO2 and PEEP
What is the hypoxemia value with acute respiratory syndrome
PaO2/FiO2 ratio
how does lung compliance change with ARDS
decrease in lung compliance
What do you change on the VENT to lower pulmonary pressures? why do you do this
low tidal volume ventilation
decreases the likehood of over distending alveoli
Hallmark imaging for asbestosis
Pleural plaques (often calcified)
When does pneumonitits present
hours after aspiration
Treatment for pneumonitis
supportive ( no abs)
Who is at risk for invasive asperigillosis?
Immunocompromised (neutropenic)
Who is at risk for chronic pulmonary asperigillosis?
Cavitary tuberculosis patients
what is CT scan of invasive asperigillosis
pulmonary nodules with surrounding ground-glass opaciites “halo sign”
What is the triad of symptoms for invasive aspirgillosis
fever
chest pain
hemoptysis
symptoms for chronic pulmonary asperigilosis
> 3 months of weight loss
cough
hemoptysis
fatigue
what are 2 causes of pneumonia due to septic emboli
bacteremia
endocarditis due to peridontal disease
side effects of albuterol
hypokalemia
tremor
palpitations
headache
when do you intubate asthma exacerbation
normal or elevated CO2
treatment for aspirin-exacerbated respiratory disease
montelukast (leukotriene receptor antagonists)
MRI of brain cancer mets from lung cancer
vasogenic edema at the gray and white matter junction
Who usually gets primary central nervous system lymphoma ? MRI imaging shows?
HIV
periventricular lesion
define chronic cough
> 8 weeks cough
3 causes of chronic cough in nonsmokers who do not have pulmonary disease
postnasal drip
GERD
asthmas
For patients with suspected post nasal drip, what is the initial treatment
oral first-generation antihistamine (chlorphenairamne)
when do you start long-term supplemental oxygen therapy for patients with COPD
- less than or equal to 88% pulse O2 saturation
2. PaO2 less than or equal to 59 mmHg
when do you start long-term O2 for patients with COPD and right CHF or increased hematoctir
- SaO2 less than equal to 89%
4. Hematocrit greater than 55%
What obstructive lung disease cause increase DLCO
asthma
What obstructive lung disease causes decrease DLCO
emphysema
Dullness to percussion
Increased intensity of breath sounds
increased tactile fremitus
crackles are often heard
Lung consolidation
Name alpha 2 adrenergic agonists ? and what they are used for?
Clonidine and methyldopa = hypertension
Dexmedetomidine –> sedation in ICU
What causes increase work of breathing in COPD patients
flattening of diaphragm has difficulty expanding
COPD how does elasticity and compliance change
Elasticity decreases
compliance increase
What are fluid characteristics of empyema and complicated parapneumonic effusion
low pH and low glucose (<60)
Difference between nonseminomatous germ cell tumors and seminoma germ cell tumor
Nonseminomatous germ –> both alpha fetoprotein and hCG
Seminomas –> No alpha fetoprotein
How do you confirm the diagnosis of granulomatosis with polyangiitis
ANCA
tissue biopsy
what lung disease increases the risk of developing active TB
silicosis
Hypertrophic osteoarthropathy, what is it? first step?
clubbing of digits
periosteal new bone formation
arthritis
get x-ray chest
Urine osmolality and urine sodium during hypovolemia
osmolality increased
sodium decreased
what are 2 causes of transudatvie plural effusion
CHF (increased hydrostatic pressure) nephrotic syndrome ( decreased oncotic pressure)
What syndrome is seen in pancoast tumor
hornor syndrome
what is the neuro involvment for pancoast tumor
weakness and/or atrophy of instrinsic hand muscles
pain and paresthesias of 4th and 5th digits, medial arm and forearm.
at what lung nodule size do you biopsy, CT scan, no risk
Biopsy: >_8mm
CT scan: 5-7 mm
no follow up:
Side effect of Nitrofurantoin? treatment
acute hypersensitivity pneumonitis
CBC –> high eosinophils
Stop meds and start steroids
difference in physical exam findings for allergic rhinitis and nonallergic rhinitis
allergic rhinitis: pale/bluish mucosa
nonallergic rhintitis: erythematous nasal mucosa
TB pleural fluid effusion
elevated protein
lymphocytic leukocytosis
low glucose levels
decreased breath sounds
Decreased tactile fremitus
Dullness to percussion over effusion
plerual effusion
cephalization of pulmonary veins
flash pulmonary edema
when does pulmonary contusion present
<24 hours after blunt thoracic trauma
differential diagnosis for pts with blunt thoracic trauma and hypoxia
- pneumothorax
- ARDS
- flail chest
- pulmonary contusion
What causes exudative effusions
capillary or pleural membrane permeability or disruptions to lymphatic flow
What is the initial evaluation for PE in pregnant women with normal chest x-ray.
V/Q scan is preferred over CT angiogram
Pregnant women with V/Q scan showing low probability for PE, what is the next step?
CT angiogram of chest
postoperative patient with hypotension, jugular venous distension and new-onset right bundle branch block likely has
massive PE
What is PaCO2 levels in PE
low, if they are high that is a concern
