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Step 2 > Uworld4 > Flashcards

Uworld4 Flashcards

1
Q

what is a common heart problem after viral myocarditis

A

dilated cardiomyopathy

- dilated ventricles and diffuse hypokinesia

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2
Q

what causes eccentric hypertrophy

A

chronic volume overload

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3
Q

what causes concentric hypertrophy

A

chronic pressure overload

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4
Q

What is the most common malignancy diagnosed in patients exposed to asbestos

A

bronchogenic carcnioma

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5
Q

what are the most common causes of secondary digital clubbing

A

Lung malignancies
cystic fibrosis
right-to-left cardiac shunts

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6
Q

clinical features of mixed cryoglobulinemia

A 
fatigue
palpable purpura 
arthralgias 
renal disease
peripheral neuropathies
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7
Q

Lab values for mixed cryoglobulinemia

A

hypocomplementemia
positive rheumatoid factor
elevated transaminases
kidney injury

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8
Q

What is required to diagnose Community-acquired pneumonia

A

presence of a lobar, interstitial, or cavitary infiltrate on chest x-ray.

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9
Q

when is sputum and blood cultures not required for CAP

A

outpatient setting, empiric oral abs are almost always curative

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10
Q

does hypoventilation cause alveolar-arterial oxygen gradient

A

no

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11
Q

what causes alveolar-arterial oxygen gradient

A

right-to-left intrapulumonary shunting
V/Q mismatch
interstitial lung disease

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12
Q

What scenario is decreased cardiac contractility observed in

A

systolic heart failure

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13
Q

what is the initial step for toxic megacolon?

A

abdominal x-ray

Surgery is only for pts not responding to medical therapy

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14
Q

What are other causes of cirrhosis other than alcohol

A
  1. viral hepatitis
  2. nonalcoholic fatty liver disease
  3. hemochromatosis
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15
Q

what causes pancreatitis complicated by hypotension

A

intravascular volume loss secondary to local and systemic vascular endothelial injury –> vasodilation, increased vascular permeability,

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16
Q

BUN levels greater than what typically causes uremic pericarditis

A

60

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17
Q

What medications can be used for patients who exercise daily with exercise asthma

A

inhaled corticosteroids or antileukotriene agents

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18
Q

Patients with severe bladder outlet obstruction due to BPH can develop what? next step?

A

acute kidney injury

renal U/S to assess hydronephrosis

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19
Q

Stain with Congo red and demonstrates an apple-green birefringence under polarized light of kidney.

A

amyloidosis

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20
Q

What is the most common cause of AL amyloidosis

A

multiple myeloma

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21
Q

What is the most common cause of AA amyloidosis

A

rheumatoid arthritis

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22
Q

Crescent formation on light microscopy

A

rapidly progressive glomerulonephritis

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23
Q

Hyalinosis that affects both afferent and efferent arterioles

A

hypertension

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24
Q

normal light microscopy

A

minimal change disease

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25
Q

how does pH change with aspirin poisoning

A

respiratory alkalosis
anion gap metabolic acidosis
normal pH, low bicarb, low PaCO2

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26
Q

What is the next step if someone has painless hematuria as an adult (age>35)

A

CT urogram and cystoscopy

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27
Q

What is the most common cause of abnormal hemostasis in patients with chronic renal failure? lab values? treatment?

A

platelet dysfunction
normal PT, PTT, and platelet count
bleeding time prolonged
Desmopressin

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28
Q

Most common cause of death in dialysis patients

A

cardiovascular

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29
Q

what leads to cyanide toxicity?

A

sodium nitroprusside prolonged infusion, especially if patient has chronic kidney disease

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30
Q

how do you treat lithium-induced nephrogenic DI

A

salt restriction and discontinuation of lithium

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31
Q

Initial choice of treatment for blacks with hypertension

A

Thiazide or CCB, alone or in combination

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32
Q

Initial treatment of choice for ethnicities with chronic kidney disease for hypertension

A

ACEI or ARB

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33
Q

What is the earliest renal abnormality seen in diabetic nephropathy

A
  1. glomerular hyperfiltration
  2. thickening of glomerular basement membrane
  3. Mesangial expansion
  4. Nodular sclerosis
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34
Q

what is the preferred method for urine microablumin

A

Spot urine collection and timed urine collection

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35
Q

What is the most common cause of nephrotic syndrome in adults, particularly African Americnas

A

Focal segmental glomerulosclerosis

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36
Q

Which kidney thing associated with HIV and heroin use

A

Focal segmental glomerulosclerosis

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37
Q

Which kidney thing is associated with Hep B and C

A

Membranoproliferative glomerulonephritis

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38
Q

what are 3 causes of astreixis

A
  1. hepatic encephalopathy
  2. uremic encephalopathy
  3. hypercapnia
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39
Q

What are urgent indications for dialysis

A

AEIOU

  1. Acidosis (pH <7.1)
  2. Electrolyte abnormality (K>6.5)
  3. Ingestion
  4. Overload, volume
  5. Uremia
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40
Q

treatment for uremic encephalopathy

A

dialysis

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41
Q

What is a risk factor for Hepatorenal syndrome

A

advanced cirrhosis with portal hypertension and edema

42
Q

what is one indication for hepatorenal syndrome

A

no improvement in renal function with fluids

decrease in GFR

43
Q

Why does hepatorenal syndrome occur?

A
  1. splanchnic arterial dilation
  2. decreased vascular resistance
  3. local renal vasoconstriction
44
Q

Name 6 medications that cause hyperkalemia

A
  1. Beta blocker
  2. ACE i
  3. ARB
  4. Spinolactone
  5. digoxin
  6. NSAIDs
45
Q

Treatment for acute hyponatremia encephalopathy?

A

3% saline

46
Q

What makes IgA nephropathy different from postinfectious glomerulonephritis

A

IgA nephropahty: within 5 days of URI. young adult men.

normal serum complements

47
Q

Interstitial cystitis

A

Bladder pain that is worsened by filling and relieved by voiding. Dyspareunia, urinary frequency and urgency can also be present.

48
Q

What is intersittial cystitis associated with?

A

psychiatric disorders and fibromyalgia

49
Q

Side effect of Rifampin

A

red urine

50
Q

What acid base values give you the best picture

A

pH and CO2

51
Q

When do you use steroids to treat hypercalcemia

A

excessive vitamine D uptake
Sarcoidosis
lymphomas

52
Q

what abs causes hyperkalemia

A

Trimethoprim

53
Q

EKG changes for hyperkalemia

A
  1. peaked t waves
  2. PR prolongation
  3. QRS widening
54
Q

Most common renal vascular lesions seen in hypertension are

A

arteriosclerotic lesions of afferent and efferent renal arterioles and glomerular capillary tufts

55
Q

acidosis does what to potassium

A

hyperkalemia

56
Q

What is the difference between vomiting and Diuretic abuse/Bartter’s syndrome

A

Vomiting: low urine chloride concentration

Diuretic abuse/Bartter’s syndrome: positive urine chloride is high

57
Q

Risk factor for correcting low sodium to normal

A

central nervous system osmotic demylination syndrome

58
Q

Risk factor for correcting high sodium to normal

A

cerebral edema

59
Q

what will show up in urine for diuretic abuse

A

urinary sodium and potassium will be elevated

60
Q

What causes membranoproliferative glomerulonephritis

A

persistent activation of the alternative complement pathway

61
Q

What acid base disturbance occurs after tonic-clonic seizure? treatment?

A

metabolic acidosis

resolves without treatment within 90 minutes following resolution of seizure activity

62
Q

What is normal anion gap

A

6-12

63
Q

MUDPILES

A 
methanol
uremia
DKA
Paraldehyde
Isoniazid/INH
Lactic Acidosis
Ethylene glycol
Salicylates
64
Q

Appropriate compensation for metabolic acidosis?

A

PaCO2 = 1.5 (serum HCO3-) +8 +/- 2

65
Q

What’s a good way to distinguish between saline responsive metabolic alkaosis and saline resistant

A

saline resistant: a disease like hyperaldosteronism, cushing,
saline responsive: diuretic/laxative abuse. vomiting

66
Q

Patients with nephrotic syndrome have increased risk of what

A
  1. atherosclerosis (due to hyperlipidiemia)

2. arteriovenous thrombosis

67
Q

Unfavorable metabolic side effects of thiazide

A

hyperglycemia
increased LDL cholestrol and plasma triglyceride
increased hyeruricemia

68
Q

Electrolyte abnormalities of thiazide

A

hypo- Na, K, Mg

Hyper - Ca

69
Q

Treatment for patients with hypertension and renal artery stenosis?

A

ACE or ARB

- surgery is reserved for resistant hypertension or recurrent pulmonary edema

70
Q

What is radiolucent? type of stone?

A

Uric acid stones (acid stones)

may be seen on U/S or CT scan

71
Q

treatment for uric acid stones

A

oral potassium citrate to alkalinze the urine

72
Q

Absorption of what is increased in Crohn?

A

oxalate

73
Q

Do you need a detailed metabolic evaluation for a first tine renal stone

A

no

74
Q

what size stone passes spontaneously with conservative management

A

less than 5 mm

75
Q

Drug used for kidney stone

A

alpha-1 receptor blocker

Tamsulosin

76
Q

Unilateral varicoceles that fail to empty when a patient is recumbent raise suspicion for?

A

underylying mass pathology (renal cell carcinoma)

77
Q

Who usually gets type 4 renal tubular acidosis

A

poorly controlled diabetics

78
Q

Type 4 renal tubular acidosis

A

hyperkalemic renal tubular acidosis
non-anion gap metabolic acidosis
persistent hyperkalemia
mild-to-moderate renal insufficiency

79
Q

Electrolyte distrubance with laxative abuse

A

hypokalemia

non-anion gap metabolic acidosis

80
Q

U/A for rhabdomyalsis

A

large amount of blood but no RBC on urine microscopy

81
Q

severe hyponatremia for SIADH treatment

A

3% saline

82
Q

Urgency incontinence? txt

A

sudden overwhelming or frequent need to void

anti-muscarinic (oxybutynin)

83
Q

Overflow incontinence? txt?

A 
constant involuntary dribbling 
cholinergic agonists (Bethanechol)
84
Q

What does positive urine leukocyte indicate?

A

pyruia

85
Q

what does positive urine nitrate indicate?

A

presence of bacteria

86
Q

Treatment for uncomplicated cystitis

A

Nitrofurantoin
Trimethoprim-sulfamethoxazole
Fofomycin

87
Q

Treatment for complicated cystitis

A

Fluoroquinolones

88
Q

What lab values should you get before starting them on lithium

A 
baseline metabolic 
calcium
pregnancy test 
thyroid function test 
U/A
89
Q

What are long term side effects of lithium

A

nephrogenic diabetes inspidus
chronic kidney disease
Hyperparathyroidism with hypercalcemia
thyroid dysfunction

90
Q

What is MRI of HIV patient

A

Diffuse increase in intensity in white matter

91
Q

Advance sleep phase syndrome

A

inability to stay awake in the evening (usually after 7pm)

92
Q

When is melatonin the first line treatment for insomnia

A

delayed sleep-wake phase disorder ( wake and sleep times different than conventional times)

93
Q

MOA for metoclopramide

A

dopamine antagonist

94
Q

MOA hyroxyzine

A

antihistamine

95
Q

MOA ondansetron

A

Serotonin antagonist

96
Q

severe MDMA intoxication

A

hyperthermia

97
Q

Trastuzumab treats what

A

HER-2 positive breast carcinoma

98
Q

Side effect of Trastuzamab

A

cardiotoxicity

99
Q

side effect of Bleomycin

A

pulmonary fibrosis

100
Q

treatment for urge incontinence

A

oxybutynin

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