UWORLD6 Flashcards
Dysphagia initially involving bot hsolids and liquids suggests
neuromuscular disorder
Structural lesions that lead to dysphagia in the pharynx and upper esophagus are visualized with
nasopharyngeal laryngoscopy
Cancers in the upper esophgaus are more likely to be
squamous cell carcinoma (vs adenocarcinoma, found primarily in the lower esophagus)
Trastuzumab is an antibody against
HER2
While anthracycline-associated cardiotoxicity may not be reversible after tx discontinuation (due to myocyte necrosis and replacement by fibrous tissue), that due to __________ is reversible
trastuzumab
A positive straight-leg raising test at a ___ degree angle or less is characteristic for nerve root irritation.
60
While scombroid poisoning symptoms include flushing, throbbing headache, palpitations, abdominal cramps, diarrhea, and oral burning; pufferfish poisoning is associated with
prominent neuro symptoms, including perioral tingling, incoordination, weakness
Red to flesh colored papules with slight central umbilication in HIV patient. Think this (in addition to Molluscum):
cutaneous cryptococcosis
Apple-jelly nodules with central atrophy and progression by peripheral extension:
cutaneous TB (lupus vulgaris)
How do you diagnose cutaneous crypto?
histopathologic examination
In whom is the warfarin INR goal 2.5-3.5?
MV replacement; AV replacement with presence of risk factors (afib, EF less than 30, prior VTE, hypercoagulable state)
Which tests are highly suggestive of patellofemoral pain syndrome?
pain elicited by extending the knee while compressing the patella; reproduction of pain with squatting
Episodic pain and tenderness at the inferior patella:
patellar tendonitis (jumper’s knee; seen in volleyball, basketball)
Localized pain and tenderness at the medial aspect of the knee joint distal to the joint line. Symptoms are usually acute/episodic (vs chronic) and not felt at the anterior knee, usually:
anerine bursitis
What is “housemaid’s knee”?
Common cause of anterior knee in patietns who work on their knees. Typically acute and HIGHLY localized with visible swelling anterior to the patella. Frequently complicated by secondary infection (septic arthritis) due to S aureus
T/F: Women less than age 30 should not be screened wit HPV
True; infection is transient
What are the features of ACL tear?
rapid deceleration or direction changes; pivoting with planted foot. Rapid onset severe pain; a “popping sensation” and significant swelling (effusion/hemarthrosis), jointinstability. Anterior laxity of tib relative to femur. Dx with MRI.
T/F: MCL injuries are not typically associated with significant hemarthrosis.
True.
Positive valgus stress test is consistent
T/F: Patients with a meiscal tear have effusions that develop slowly.
True
Hemarthrosis is rare
What comprises the latent stage of labor?
Stage 1. 0-6 cm cervical dilation
What comprises active stage of labor?
Stage 1. 6-10 cm cervical dilation
What is the 2nd stage of labor?
10cm (complete) cervical dilation to delivery
What is stage 3 of labor?
delivery of baby to expulsion of placenta
What is arrest of labor in the first satge?
Greater than 6 cm dilation, ruptured membranes, and
1) no cervical change for 4 hours despite ADEQUATE contractions; OR
2) no cervical change for 6 hours with INADEQUATE contractions
What is “adequate labor” in terms of Montevideo units?
200-250 units or greater
Which drug is used for cervical ripening and labor induction? What class of drug is it?
misoprostol! a prostaglandin
What are the indications for parathyroidectomy in patients with 2* or 3* hyperparathyroidism?
1) calcium levels over 10.5 not responding to conservative management
2) mod to severe hyperphos
3) PTH greater than 1000
4) intractable bone pain
5) intractable pruritus
6) episode of calciphylaxis
7) soft tissue calcification
Patients with alarm symptoms or older than age ___ should undergo endoscopy.
55
alarm symptoms = abdominal mass or LAN, unexplaind anemia, FH of gastric cancer, worsening dysphagia or odynophagia, persistent vomiting or hematemesis, unintentional weight loss
The major problem that leads to difficulties finding cross-matched blood in patients with a history of multiple transfusions is:
alloantibodies
Though premixed insulins (eg 70/30) can provide sometimes larger declines in hemoglobin a1c compared to long-acting basal insulins, they are also more likely to cause these two negative side effects:
1) higher risk of hypoglycemia
2) weight gain
Bile-salt induced diarrhea occurs in 5-10% of patients following cholecystectomy and in patients with short bowel syndrome. What is the treatment?
cholestyramine
What is the treatment of choice in cases of ethylene glycol and methanol intoxication?
Fomepizole
How does DIC affect D-dimer, PT, PTT, and fibrinogen?
D dimer = elevated (accelerated fibrinolysis)
PT and PTT: prolonged (depletion of clotting factors)
fibrinogen: low (due to consumption)
Which diabetes meds can cause nasopharyngitis?
DPP4 inhibitors, like sitagliptin or saxagliptin
Which diabetes meds cause diarrhea/flatulence?
a-glucosidase inhibitors, like acarbose and miglitol
Which diabetes meds cause weight gain and hypolgycemia?
sulfonylureas (like glyburide, glipizide, glimepiride) and meglitinides (nateglinide, repaglinide)
FLexible kyphosis is normal or slightly increased thoracic kyphosis seen on lateral radiographs, from which angles?
20-40
The radiographic finding of a “collar on the neck of the Scotty dog” is typical of
spondylolisthesis: an anterior slippage of the vertebral body, usually in the lower lumbar vertebrae
As long as structural kyphosis is not severe (less than ___ degrees), a Milwaukee brace can be used.
70-80 degrees.
In more severe cases (significant angulation, intractable pain, and neurological abnormalities), surgical correction is used.
What is the treatment for classic pneumonia in a kid?
high dose amoxicillin (for Strep pneumo)
What are the common causes of hepatic encephalopathy?
- GIB
- hypoK
- hypovolemia
- hypoxia
- sedatives, tranquilizers
- hypoglycemia
- metabolic alkalosis
- infection (including SBP)
- high protein intake
Why isn’t antenatal corticosteroid therapy given IV?
results in peaks and troughs. IM administration (of betamethasone, dexamethasone) provides stable and predictable concentrations
ICD placement is indicated for prevention of SCD in which patients with HCM?
high risk for malignant arrhthmias: ie 1) FH of SCD, 2) prior history of cardiac arrest or sustained, spontaneous VT; 3) recurrent or exertional syncope, 4) nonsustained VT, 5) hypotension with exercise, 6) extreme LVH)
What med is given for cat bites?
amox/clav OR doxy (if patient allergic to PCN)
What is the most common extraneural complication of myelomeningocele?
1) Bladder dysfunction! (lumbar region involvement can cause upper urinary tract involvement and renal dysfunction)
followed by GI involvement (S2-S3 –> fecal incontinence) and then lower extremity fractures
What is the only diagnostic marker for acute HBV infection in the “window period”?
IgM anti-HBc
What are the 3 situations in which isolated anti-HBc may be seen?
1) during the “Window period” of acute HBV infxn when HBsAg has fallen but anti-HBs has not risen (IgM anti-HBc positive, LFTs elevated)
2) years after recovery from acute HBV (IgM anti-HBC negative, LFTs nl);
3) chronic HBV infxn when HBsAg has fallen to undetectable level. Evidence of chronic liver disease and HBV DNA is detectable (IgM anti-HBC is negative)
Maculopapular rash that spreads caudally, low-grade fever, LAN involving posterior cervical and occipital lymph nodes, nonspecific symptoms (but less lick than measles):
rubella
**not as sick as rubeola (measles); also, measle’s rash is more brick red
Describe measles:
cough, conjunctivits, coryza. Fever and photophobia are common. Blue-white Koplik spots found on buccal mucosa precede appearance of caudally spreading maculopapular rash
*also known as rubeola
Foot eversion is a function of which muscles, innervated by which nerves?
Fibularis longus and brevis (innervated by the superficial fibular nerve; also responsible for plantar flexion) and fibularis tertius (deep fibular nerve)
An effusion in the middle ear (normal appearing TM with decreased mobility on pneumatic otoscopy) can persist for up to __ months after an acute episode of otitis media.
up to 3 months. If it persists longer, hearing should be assessed
Otitis media is treated with amoxicillin. If that doesn’t work, which antibiotics are used next?
- amox-clav, 2. cerfuroxime, 3. ceftriaxone
Elevated levels of cathepsin D in breast cancer is associated with a (better/worse) prognosis
worse
How do you treat serotonin syndrome?
benzodiazepines, supportive measures, discontinuation of serotonergic drugs. In severe cases, cyproheptadine (serotonin antagonist) may be used
Neuroleptic malignant syndrome is similar to serotonin syndrome, but does not feature:
hyperreflexia or clonus.
In addition, it is characterized by bradykinesia and “lead pipe” muscular rigidity, differing from the hyperkinesia of serotonin syndrome
Which patients are considered for bacterial endocarditis prophylaxis?
prosthetic valves, hx of endocarditis, unrepaired cyanotic CHD, repaired CHD using prosthetic material in the first 6 months, repaired CHD with residual defects, heart transplant with valvular disease
In which scenarios do patients get bacterial endocarditis ppx?
high risk procedures: dental manipulation (amoxicillin/ampicillin),
respiratory tract procedures with incision or biopsy, procedures in patietns with established ongoing GI/GU infection (amoxicillin/ampicillin),
or infected skin or musculoskeletal tissue (vanc/clinda). OR cardiac surgery
How can you differentiate between TSH-secreting pituitary adenoma and thyroid resistance syndrome, both of which are characterized by elevated TSH, T3 and T4?
Though both have elevated TSH, T3, and T4, in TSH-secreting pituitary adenoma, there are increased a-subunit levels
ALSO, those with thyroid hormone resistance syndrome are likely to be hypothyroid.
What is familial dysalbuminemic hyperthyroxinemia?
These patients have increased T4 and normal T3 because abnormal albumin has a high affinity to T4 but not T3. These patients have normal TSH
Clinically, how can you differentiate between PMR and polymyositis?
Polymyositis is generally characterized by muscle weakness (not pain)
What are Forschheimer spots?
Patchy erythema on the soft palate (seen in rubella)
T/F: Management of saggital sinus thrombosis requires heparin anticoagulation, even when there is hemorrhagic infarction on CT
True! Hemorrhagic foci are 2/2 to venous hypertension in this case
Patients who are going to be treated with corticosteroids for more than 3 months (or more than 6 months at
baseline and every year
Treatment with what is beneficial for patients with hypertension and CKD who have proteinuria > 500-1000 mg/day
ACEI/ARB
The diagnosis of acute mesenteric ischemia is best made wiith?
CT angiogram
How does acute COLONIC ischemia present?
transient reudction in blood flow to colon due to hypovolemic states/ischemia to bowel. Watershed areas (splenic flexure, rectosigmoid). More lateralized abdominal pain followed by bloody diarrhea. Pain is mild to moderate
Symptomatic pulmonary disease is usually an indication for WHAT therapy in sarcoidosis (esp if accompanied by systemic symptoms like severe fatigue, fever, and hypercalcemia).
corticosteroid therapy
What are contraindications to the DTaP vaccine?
A hx of anaphylaxis or encephalopathy w/in 7 days of DTap are true contraindications. Temporary contraindications include moderate or severe illness (with fever); administer when fever resolves
Which meds are associated with development of Cdiff?
FLQs, enhanced spectrum PCNs, cephalosporins, and clinda
Syndeham’s Chorea develops how long after streptococcal infection?
1-8 months! (carditis and arthritis develop within 3 weeks)
SC is characterized by emotional lability and irregular, rapid jerking movements of the face, hands and feet
What is tetrabenazine?
a dopamine antagonist used for Huntington disease
What are the major criteria for acute rheumatic fever? Minor criteria?
Major: JONES (migratory arthritis, carditis, subcutaneous nodules, erythema marginatum, syndenham chorea)
minor: fever, arthralgias, elevated ESR/CRP, prolonged PR
Describe “senile gait”
“walking on ice!” Feet wide apart, knees and hps flexed, arms flexed and extended as if expecting to fall
Describe spastic parapesis:
patient drags legs forward with every step. Characteristic circular leg movements, known as “scissoring gait”
What is the gait in cerebellar ataxia?
“drunken sailor gait.” Jerky gait, zigzag partner, irregular rhythm of steps
What is the gait in distal LMN disease?
steppage gait, foot drop, excessive elevation of the legs during walking (toes touch the floor before heels)
What are the treatments for endometriosis?
medical: NSAIDs, GnRH analogs, danzol (synthetic androgen) and OCPs
surgical: removement of lesions through bipolar coagulation
* *in a patient with severe symptoms (including infertility), laparascopy for establishing diagnosis must be performed first
Which patients with Hep C should be treated with interferon and ribavirin?
chronic Hep C having HCV RNA positive, consistently elevated ALT, and at least MODERATE inflammation on liver biopsy.
Normal ALT level and mild inflammation without fibrosis can be observed
Microhematuria and anemia are classic for which infective disease?
schistosoma haematobium. Diagnosed with urine microscopy to demonstrate parasite eggs in teh urine (or the stool)
What can prevent febrile nonhemolytic reaction?
leukoreduction
HSP is a nonblanchable nonpruritic vasculitis across legs and buttocks due to
IgA deposition
What is the intermittent and nausea in HSP due to?
small-bowel intussuception
What is antecedent to HSP in 50% of patients?
URI
What is the triad of HUS? What is the pentad of TTP?
HUS triad: microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure
TTP pentad: microangiopathic hemolytic anemia, thrombocytopenia, renal failure, AND fever and neuro impairment (like confusion)
Who should get CTs for lung cancer? When?
low dose chest CT yearly, ages 55 - 80, and if patient has 30 pack years or more AND the patient is a current smoker or quit smoking in the last 15 years
STOP if patient over age 80, if they quit smoking for 15 years or more
Which conditions have increased carpal tunnel?
DM, RA, and hypothyroidism.
Also obesity, wrist trauma/fx, acromegaly, pregnancy, mmenopause, and ESRD
When is surgery indicated for carpal tunnel syndrome?
motor weakness, atrophy of the thenar eminence. Or when conservative treatments have failed
What are safety concerns of long term PPI use?
increased risk of osteoporosis and hip fracture. Increased enteric infections, hypo mag, interstitial nephritis, and decreased absoroption of B12 and iron
When do you swtich from IV insulin infusion to SQ in management of DKA and HHS?
able to eat, glucose less than 200, anion gap less than 12, HCO3 greater than or equal to 15
When is anterior shoulder pain seen?
patients with acromioclavicular or glenohumreal joint osteoarthritis and biceps tendonitis
When is lateral shoulder pain seen?
rotator cuff tendonitis
When is posterior shoulder pain seen?
referred from cervical spine (nerve impingement, spinal stenosis)
All patients initially diagnosed with Turner syndrome require:
visual and hearing assessment, renal ultrasound (predisposed to kidney amlformation like horseshoe shaped kidney), and TSH level measurement (predisposed to autoimmune endocrinopathy esp hypothyroidism)
Streak goands in Turner’s syndrome increase a patient’s chances for malignancy when…
there is an associated mosaicism with a Y chromosome
Most physicians begin prescribing hormone replacement therapy for Turner’s patients when they reach ___ years of age
14 years of age
