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Step 3 UWorld Flashcards

1
Q

5 reasons you would immediately remove a tunneled catheter in an infected patient

A
  1. Pus at the site
  2. Severe sepsis
  3. Hemodynamics instability
  4. Evidence of metastatic infection
  5. No improvement after 72hrs of antibiotics
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2
Q

Next step for infected patient with tunneled catheter who gets worse on day 4 of Vanco with midline low back tenderness

A

MRI spine

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3
Q

What is associated with restless leg syndrome and what test should you make sure to order?

A

Iron deficiency anemia

Ferrritin (<75 ng/dL)

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4
Q

How high do you expect aminotransferases to be in viral hepatitis?

A

> 1000

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5
Q

Concerns with Kava Kava supplement and what its used for>

A

Used for anxiety

Can cause hepatotoxicty and liver failure

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6
Q

Thiazide side effects

A

Hypokalemia
Hyponatremia
Hyperuricemia
High glucose and high cholesterol

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7
Q

Concerns with ginko baloba

A

Increased risk of bleeding due to anticoagulant and antiplatelet effects

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8
Q

Concerns with ginseng

A

Headache, insomnia, and GI symptoms

Vaginal bleeding and hypoglycemia

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9
Q

Treatment of restless leg syndrome

A 
Dopamine agonists (pramipexole or ropinirole)
Alternate:  benzos or gabapentin - Alpha -2-delta calcium channel ligands
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10
Q

Concern for subarachnoid hemorrhage. 1st and 2nd step if 1st step is negative

A

1st Get CT head

If negative get LP. Xanthochromia confirms SAH

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11
Q

In opioid withdrawal why would methadone be preferred over buprenorphine?

A

Buprenorphine can worsen withdrawal symptoms since it is a partial opioid antagonist.

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12
Q

Why would you choose clonidine over methadone in treating opioid withdrawal?

A

Methadone requires supervision in an inpatient or outpatient setting. May require official detox treatment

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13
Q

Patient with seizures on phenytoin starts to have horizontal nystagmus. What do you do?

A

Taper the dose down

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14
Q

How do phenytoin and oral contraceptives interact?

A

Phenytoin increases the metabolism of oral contraceptives making the risk of pregnancy higher.
Oral contraceptives don’t affect phenytoin levels

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15
Q

How does CKD affect phosphorus, calcium, parathyroid hormone, and vitamin d?

A

Phosphorus increases - not filtered

Vitamin D decreases - it doesn’t get converted to active vitamin d by the kidney

Calcium decreases - decreased vitamin d leads to decreased calcium absorption in the gut

Parathyroid hormone increases - increases due to low calcium and high phosphorus in order to remove excess phosphorus and break down bone to increase calcium

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16
Q

What happens when secondary hyperparathyroidism continues during CKD?

A

Tertiary hyperparathyroidism

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17
Q

Calcium and parathyroid levels in tertiary hyperparathyroidism?

A

Hypercalcemia and very high PTH due to autonomous PTH secretion

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18
Q

3 indications for parathyroidectomy in tertiary hyperparathyroidism

A
  1. Persistently elevated calcium, phosphorus, and parathyroid hormone
  2. Soft tissue calcification or calciphylaxis (vascular calcification with skin necrosis)
  3. Intractable bone pain or pruritus
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19
Q

2nd and 3rd MCP with narrowing, subchondral sclerosis, curved osteophytes, subchondral cysts, and osteopenia with joint aspirate that has positively birefringent rhomboid crystals

A

Hereditary hemochromatosis

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20
Q

What do patients with hereditary hemochromatosis have an increased risk of developing?

A

Hepatocellular carcinoma

21
Q

STOP BANG survey for obstructive sleep apnea

A

Snoring
Tiredness (excessive daytime)
Observed apneas
Pressure elevated (bp)

BMI < 35
Age < 50
Neck size. 17 in. for men, 16 in. For women
Gender (male)

22
Q

For what disease would you use modafinil?

A

Narcolepsy

23
Q

Medical treatment for asymptomatic left ventricular systolic dysfunction? 1st and 2nd steps

A

ACE-I like lisinopril or ARB like losartan. They delay heart failure symptoms and improve cardiac morbidity and mortality

Beta blocker should be added once the ACE-I or ARB is at an appropriate dose

24
Q

When would you treat an infant with hyperbilirubinemia with exchange transfusion? (3)

A
  1. T Bili 20-25
  2. Worsening hyperbilirubinemia after phototherapy
  3. Bilirubin induced neuro dysfunction - lethargy
25
Q

What conditions are needed for ABO hemolytic disease?

A

Infant with A+ or B+

Mom’s with O+ who have A and B antibodies.

26
Q

Difference between
Provisional tic disorder
Chronic tic disorder
Tourette’s syndrome

A

Provisional tic disorder- 1 type of tic for < 1 yr

Chronic tic disorder - 1 type of tic for > 1 yr

Tourette’s- multiple motor and greater than 1 vocal tic for > 1 yr

27
Q

What kind of drug is risperidone?

A

2nd generation anti-psychotic

28
Q

What drugs can be used to treat Tourette’s? 4 classes

A

1st gen anti-psychotic: haloperidol and fluohenazine

2nd gen anti-psychotic: risperidone and aripiprazole

Alpha-2 agonist: guanfacine and clonidine

Dopamine depleter: tetrabenazine

29
Q

1st line treatment for primary dysmennorhea in non-sexually active and sexually active patients?

A

Not sexually active - (NSAIDS) naproxen

Sexually active - combined oral contraceptives

30
Q

First line treatment for onychomycosis

A

Terbinafine

Itraconazole

31
Q

Treatment for DVT or PE?

A

Greater than or equal to 3 months of factor Xa inhibitor like rivaroxaban

32
Q

Treatment for a woman on menopausal hormonal treatment who develops a DVT

A

Must stop hormone therapy. Can switch to a SSRI or SNRI

33
Q

Sickle cell maintenance (4)

A

1) pneumococcal vaccine
2) Penicillin until age 5
3) Folic acid supplementation
4) hydroxyurea

34
Q

Sickle cell acute pain crisis treatment

A

Hydration
Analgesia
+/- transfusion

35
Q

Septic arthritis lichee criteria (4)

A 
Non weight bearing
Fever > 38.5
Leukocytosis
ESR > 40
CRP > 2
36
Q

Infected joint. What antibiotic should you use and why?

A

Vancomycin to cover staph aureus and streptococci

37
Q

Diffusely increased thyroidal uptake of radioactive iodine diagnoses what?

A

Graves’ disease- hyperthyroidism

38
Q

What is subclinical hyperthyroidism?

A

Low TSH and normal T3 and T4

39
Q

How and when do you treat subclinical hyperthyroidism?

A

Treat with antithyroid medication or radioactive iodine

Treat when TSH < 0.1
Or at increased risk due to
Age >65
Comorbidities like osteoporosis and heart disease

40
Q 
FEV1
FEV1/FVC ratio
TLC
DLCO
In asthma, COPD, restrictive lung disease, and pulmonary arterial hypertension
A

Asthma
Not active sxs - normal FEV1, FEV1/FVC, DLCO, and TLC
Active sxs - just like COPD. Bronchodilator improves FEV1 by 15%

COPD
Decreased FEV1
Decreased FEV1/FVC
Decreased DLCO ( differs from asthma)

Restrictive lung disease
Decreased FEV1
Proportionally decreased FVC -> normal FEV1/FVC
Decreased TLC

Pulmonary arterial hypertension
Decreased DLCO
Otherwise normal

41
Q

Most specific findings of cardiac tamponade physiology

A

Right atrial and right ventricular collapse

42
Q

Beck’s triad of cardiac tamponade

A

Hypotension
JVD
Decreased heart sounds

43
Q

What is the cause of the symptoms in toxic shock syndrome?

A

Staph TSS toxin-1. Its an exotoxin. Widespread T cell activation due to exotoxin acting as a superantigen

44
Q

Distinguishing features between PSGN and IgA nephropathy

Timing after an infection
Gross hematuria
RBC casts
Complement levels

A

10 days after infection for PSGN
Sooner for IgA

Gross hematuria in IgA, but not PSGN

Both have RBC casts

Complement decreased in PSGN and normal in IgA

45
Q

What is the mechanism of amantadine?

A

Dopamine agonist

46
Q

How do you treat an acute dystonic reaction?

A

Anticholinergics - benztropine

Antihistamines - diphenhydramine

47
Q

What is the mechanism of amantadine?

A

Dopamine agonist

48
Q

How do you treat an acute dystonic reaction?

A

Anticholinergics - benztropine

Antihistamines - diphenhydramine

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