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Flashcards in Random2 Deck (176):
1

Scleroderma renal crisis findings? (5)

- Acute renal crisis (w/o previous renal disease)
- Malignant HTN (ie headache, n/, blurry vision)
- U/A mild proteinuria
- Microangiopathic hemolytic anemia w/ fragmented RBCs (schistocytes)
- Thrombocytopenia

2

Schistocyte?

Fragmented RBC

3

Fragmented RBC?

Schistocyte

4

Echinocyte is?

Burr cell
- spiculated appearing RBCs
- seen in liver disease and end-stage renal disease

5

Burr cell is?

Spiculated appearing RBCs w/ serrated edges seen in liver disease and end stage renal disease

6

Howell-jolly body is?

Basophilic remnants of the nucleus that appear as small, black pellets in RBCs
- seen in pts w/ hx of spelnectomy or functional asplenia

7

When do you see howell-jolly bodies?

- Pts w/ hx of spelnectomy
- Functional asplenic pts

8

Another name for acanthocyte?

Spur cell

9

Another name for echinocyte?

Burr cell

10

Burr cells other name?

echinocyte

11

Spur cell other name?

acanthocyte

12

What is a spur cell?

RBCs w/ irregularly sized and spaced projections
- seen in liver disease

13

WHen are spur cells seen?

In liver disease

14

Spiculated RBC - think?

Burr cell
- liver and endstage renal disease

15

Target cells are?

RBCs w/ central density surrounded by pallor (bull's eye)

16

Target cell seen w/?

- Hemoglobinopathies (ie thalassemia)
- Chronic liver disease (esp obstructive liver disease)

17

Thalassemia has what type of abnl RBCs?

Target cells

18

Main CXR finding on aortic injury?

Mediastinal widening

19

Initial screening study for aortic injury?

CXR

20

main causes of aortic traumatic injury?

MVAs and falls from >10 feet

21

what is often associated finding on CXR w/ myocardial contusion?

rib fractures

22

How do glucocorticoids effect lymphocytes, eosinophils, and neutrophils?

- Inc Neutrophils (left shift)
- Dec lymphocytes and eosinophils

23

recent cardiac cath + heparin in prep of CABG, now w/ hypotension, tachycardia, flat neck veins and back pain -- think?

Retroperitoneal hematoma
- due to bleeding from the arterial access site

24

recent cath + hemodynamic instability + flank/back pain think?

retroperitoneal hematoma

25

how to confirm dx of retroperitoneal hematoma?

NON-contrast CT scan of abdomen and pelvis
or
abdominal u/s

26

treatment of retroperitoneal hematoma

supportive
- intense monitoring
- bed rest
- IV fluids
- bld transfusions as needed

*Rarely needs surgery

27

First line treatment for specific phobia?

Behavioral therapy (assuming enough time)

28

Treatment of specific phobia if not enough time (ie flight next week?)?

Benzodiazepines

29

eye movement desensitization useful in what disorder?

PTSD

30

industrial worker + pleural calcifications - think?

asbestos exposure

31

good way to distinguish b/t restrictive lung disease causes?

look at diffusion capacity (DLco)
- wall issue (ie obesity, ankylosing spondylitis) --> normal diffusion capacity
- Interstitial lung disease --> low DLco

32

Way to distinguish b/t obstructive lung diseases?

Bronchodilator challenge
- If FEV1 improves - think asthma
- if no change, think COPD

33

first line mood stabilizers for bipolar maintenance?

- Lithium (renal and thyroid toxic)
- valproate (hepatotoxic, thrombocytopenia)

34

associated adverse effects of Lithium?

- adverse effects on kidneys and thyroids
kidneys: nephrogenic DI or chronic tubulointerstitial nephropathy

35

Valproate adverse effects?

- rare hepatotoxicity
- thrombocytopenia

36

what is bupropion?

Antidepressant
- NE and dopamine reuptake inhibitor (NDRI)

37

antidepressants w/ bipolar patients can cause what?

inducing mania (so don't use)

38

drugs that may be useful for long term maintenance of pts w/ bipolar?

-Lithium (1stline)
- Valproate (1stline)
- Quetiapine (antipsychotic 2nd gen)
- Lamotrigine (anticonvulsant)

39

What is topiramate

anticonvulsant

40

main pharmacologic target for treatment of OCD?

serotonin

41

First line treatment of OCD?

- SSRI
(fluoxetine, fluvoxamine, paroxetine, citalopram, escitalopram, sertraline)
- Cognitive-behavioral therappy

42

2nd line treatment of OCD?

clomipramine (tricyclic antidepressant, less well tolerated than SSRI - 1st line)

43

antipsychotics target what?

dopamine

44

primary target of benzodiazepines?

Gamma-aminobutyric acid

45

post MI few days + new pain that hurts more supine and improved on sitting up and leaning forwards - think?

acute pericarditis

46

ECG findings for acute pericarditis?

- Diffuse ST elevations
- PR depressions

47

post MI 3-7 dys, now w/ new onset systolic murmur - think (2)?

- interventricular free wall rupture
- Papillary muscle rupture (MR)

48

major depressive episode should last how long for dx?

>2wks

49

Atypical depression symptoms (4)?

- Hypersomnia
- Increased appetite
- Rejection sensitivity
- Leaden Paralysis (heavy feeling limbs)

50

timing for adjustment disorder?

symp dev w/in 3 mo of stressor and last no more than 6 mo after stressor ends

51

Low mood lasting most of the day on more days than not for at least 2 years?

Persistent depressive disorder (dysthymia)

52

timing for persistent depressive disorder (dysthymia)

- low mood lasting most of the day on more days than not
- At least 2 years

53

first line treatment for absence seizure?

Ethosuximide

54

EEG w/ classic 3 Hz spike wave pattern - think?

Absence seizure

55

1st and second line treatments for absence seizure?

1) Ethosuximide
2) Valproic acid (side fx)

56

Methylphenidate is?

stimulant used to treat ADHD

57

Atomoxetine is?

Nonstimulant med used to treat ADHD

58

Lorazepam is?

Benzodiazepine

59

Lorazepam used for?

Benzo used for anxiety and acute managment of prolonged seizures (ie status epilepticus)

60

Phenytoin used for as 1st line for what?

Generalized tonic-clonic seizures or focal seizures

61

Side fx of phenytoin? (3)

- Gingival hyperplasia
- Stevens Johnson syndrome
- Toxic epidermal necrolysis

62

where is lesion that causes hemi-neglect syndrome

Lesion on non-dominant (usually R) PARIETAL lobe

63

What part of brain hurt --> hemi-neglect?

Parietal lobe (non dominant side, usually R)
- in charge of spatial organization

64

lesion on frontal cortex would cause?

Hemiparesis
- w/ motor aphasia if dominant lobe involved (Broca's, expressive aphasia)
- maintained comprehension, but speech is stilted and effortful

65

Left temporal lobe damage -->?

Receptive aphasia (Wernike's)
- cannot comprehend written or spoken language
- expresses fluently, although incoherently

66

occipital lobe damage results in?

visual distrubances

67

ansognosia?

pt unaware of deficit (ie unaware of hemineglect)

68

comb only R side, clock only on R side - this is?

hemi neglect

69

pulsus paradoxus associated w/?

cardiac tamponade

70

systolic murmur that increases w/ standing is?

Hypertrophic obstructive cardiomyopathy (HOCM)

71

good way to tell syncope vs seizure in non-witnessed pt?

syncope would immediately return to neurological baseline, while seizures would be delayed, sleepy, confused

72

bilious vomiting + contrast from upper GI series in corkscrew appearance - think?

small bowel volvulus

73

Ligamentz of Treitz on R side of abdomen on upper GI series - think?

Malrotation

74

stable neonate w/ bilious vomiting + xray finding no free air or double bubble, next step?

Upper GI series to look for malrotation (-> volvulus)

75

bilious vomiting neonate - diff dx (4)?

- Malrotation (-> volvulus)
- Duodenal atresia
- Hirschsprung disease
- Meconium ileus

76

What procedure done to fix malrotation and prevent volvulus?

Ladd procedure

77

bilious vomiting stable neonate + dilated loops of bowel on xray --> next step to dx b/t?

Next step: Contrast Enema
- Microcolon --> Meconium ileus
- Rectosigmoid transition zone (b/c tonically contracted distal to) --> Hirschsprung disease

78

lesion in the brain + personality changes and strange behavior localize it to what area of brain?

frontal lobe

79

brain lesion w/ butterfly appearance w/ central necrosis - think?

Glioblastoma multiforme

80

brain metastasis usually look and are found?

Look:
Found in gray-white junctions or at watershed zones

81

a high grade astrocytoma may also be known as?

Glioblastoma multiforme (grade 4 astrocytoma)

82

heterogenous, serpiginous contrast enhancement can be found w/ what brain lesion?

High-grade astrocytoma (incl GBM)

83

Liver disease w/ acute onset of kidney issues --> think?

Hepatorenal syndrome

84

liver disease + inc creatinine + failure to respond to IV fluids + absence of shock, proteinuria, specific reason for renal disease --> think?

Hepatorenal syndrome

85

Treatment of hepatorenal syndrome?

Liver transplant

86

Pulsus paradoxus - diff dx (6)?

- Cardiac tamponade
- Asthma
- Chronic COPD
- OSA
- Pericarditis
- Croup

87

Pulsus parvus et tardus - think?

aortic stenosis

88

Inspiration causes what?

inc systemic venous return to heart

89

Tic douloureux is?

Trigeminal neuralgia

90

etiology of trigeminal neuralgia (tic douloureux)?

compression of the trigeminal nerve (pain along 2 & 3rd branches)

91

tongue palsy results from damage to what nerve?

hypoglossal nerve

92

facial nerve does what?

- muscles of facial expression
- Taste: ant. 2/3 tongue

93

jaw asymmetry can result from what nerve damage?

Mandibular division of the trigeminal nerve (V3) --> paralysis of muscles of mastication

94

winged scapula - what nerve hurt?

long thoracic nerve

95

MS does what to nerves?

autoimmune disease --> inflammatory demyelination of axons in CNS

96

ocular issues + fatigable chewing + dysphagia w/ nasopharyngeal regurge + dysarthria - think

Myasthenia Gravis

97

tall R wave in aVL + Deep S wave in V3 + repolarization changes in anterolateral leads (I, aVL, V4-6) - think?

Hypertrophic cardiomyopathy
- tall and deep waves indicate LVH

98

violent behavior + hallucinations + nystagmus - what drug?

PCP intox

99

Visual hallucinations + tachy/HTN - what drug?

LSD intox

100

Chest pain + seizures + agitation + Mydriasis + tachy/HTN --> what drug?

Cocaine intox

101

tooth decay + choreiform movements + sweating + psychosis/violence - what drug?

Meth intox

102

increased appetite + conjunctival injection + impaired time perception - what drug?

marijuana intox

103

Depressed mental status + Miosis + respiratory depression - what drug?

Heroin intox

104

resp depression, pinpoint pupils, CNS depression, hypotension - think?

Opioid overdose

105

subperiosteal hemorrhage newborn?

cephalohematoma

106

newborn head swelling few hours later that does NOT cross suture lines - think?

cephalohematoma

107

swelling of newborn head seen right after birth - think?

caput succedaneum

108

diffuse swelling of newborn scalp that crosses suturelines and midline - think?

caput succedaneum

109

good indications of cranial meningocele

- pulsations
- increased pressure upon crying
- bony defects

110

small-vessel hyalinosis - aka?

lacunar stroke

111

kussmaul's sign is?

increase in JVD w/ inspiration

112

increase in JVD w/ inspiration is known as?

kussmaul sign

113

wallenberg syndrome due to?

lateral medullary infarction likely due to an occluded intracranial vertebral artery

114

Vestibulocerebellar symptoms in wallenberg syndrome

- nystagmus (horz and rotational)
- diplopia
- vertigo w/ falling to side of lesion
- difficulty sitting upright w/o support
- Ipsilateral limb ataxia

115

wallenberg syndrome findings? (6)

- vertigo (fall to side of lesion)
- nystagmus
- ipsilateral loss of pain and temp on face
- contralateral loss of pain and temp on trunk and limbs
- Horner's syndrome
- Hoarseness

116

weakness of muscles of mastication, diminished jaw jerk reflex, and impaired tactile and position sensation over face - where is lesion?

Lateral mid-pons
- effects ipsilateral trigeminal nerve

117

Lateral mid-pons lesion would effect what nerve?

Ipsilateral trigeminal nerve

118

lateral medullary infarct effects what nerves?

IX and X
--> hoarseness, dysphagia, diminished gag reflex

119

paralysis of the arm and leg w/ loss of tactile and position sense + tongue deviation -- think?

Medial medullary syndrome

120

lesion on medullary pyramid causes?

contralateral hemiparesis

121

lesion on medial lemniscus causes?

contralateral loss of tactile, vibratory, and position sense

122

medial medullary lesion effects what cranial nerve?

Hypoglossal (XII)
--> ipsilateral tongue paralysis w/ deviation to side of lesion

123

Alternating hypoglossal hemiplegia is also known as ?

medial medulary syndrome
- contralateral hemiparesis
- tongue deviation to ipsilateral side of lesion

124

contralateral ataxia + hemiparesis of the face, trunk, and limbs - think?

medial mid pontine infarction

125

lateral medullary infarct occurs due to?

- occlusion of the post. inf cerebellar or vertebral artery

"wallenberg syndrome"

126

neutrophilic cryptitis in GI - think?

IBD (Crohn's or UC)

127

epithelial ecrosis in GI - think?

Ischemic colitis

128

conversion disorder is?

sudden onset of neurological symptom that is incompatible w/ nL neuro exam brought on by a stressor

129

somatic symptom disorder is?

1 or more persistent physical symptoms that causes disproportionate and excessive anxiety and energy devoted to it.

- generally symp is minor but anxiety is big

130

sildenafil is?

phosphodiesterase 5 inhibitor

131

sildenafil has cross reaction w/ what drugs (2)?

- alpha blockers (-zosins)
- nitrates

can cause hypOtension

132

sildanefil first line for?

erectile dysfunction treatment

133

IV drug user --> endocarditis think what valve?

Tricuspid

134

IV drug user + endocarditis murmur effected how w/ inspiration?

Increased murmur w/ inspiration (TR)

135

IV drug user + endocarditis + round alverolar infiltrates on CXR - think?

septic emboli to lungs

136

mumur best heard while sitting up -- think?

AR

137

Paradoxical splitting -- think?

LV outflow obstruction
- AS
- LBBB
- R ventricular paced rhythm

138

Tricuspid endocarditis --> what murmur?

TR

139

pleural plaques - think?

Asbestosis

140

unilateral pleural abnormality w/ large pleural effusion in plumber - think?

pleural mesothelioma

141

AST ALT levels in alcoholic liver disease?

AST:ALT --> 2:1
AST & ALT

142

Marked elevations in AST and ALT (>25x) -- think? (3)

- toxin induced
- ischemia
- viral hepatitis

143

What location in brain usually has NO hemiparesis if there is a lesion?

Cerebellum

144

Facial weakness + ataxia + nystagmus + headache + neck stiffness + n/v -- think where is lesion?

Cerebellum
- note: NO hemiparesis

145

contralateral hemiparesis + hemianesthesia + conjugate gaze deviation toward lesion - think where is lesion (2)?

1) putamen + internal capsule (Basal ganglia)

2) occlusion of proximal middle cerebral artery (more acute onset)

146

eyes react how when there is a hemorrhage at the thalamus?

eyes deviate Towards hemiparesis (contralateral to bleed)

147

contralateral hemiparesis + hemisensory loss + nonreactive miotic pupils + upgaze palsy + eyes deviate towards hemiparesis - where is hemorrhage?

Thalamus

148

Deep coma and total paralysis w/in minutes + pinpoint reactive pupils - where is hemorrhage?

Pons

149

cerebral lobe bleed w/ contralateral hemiparesis + eyes deviate away from hemiparesis - location?

frontal lobe

150

cerebral lobe bleed w/ contralteral hemisensory loss - location?

parietal lobe

151

cerebral lobe bleed w/ homonymous hemianopsia - location?

occipital lobe

152

Lead poisoning risk next step?

venous lead level

153

Treatment of lead poisoning? (mild, mod, severe)

- mild (5-44): no meds, repeat venous lead level in =70): Dimercaprol (BAL) + calcium disodium edtate (EDTA)

154

Dimercaprol (BAL) + EDTA can treat what?

severe lead poisoning

155

Dimercaprol + calcium disodium edetate can treat?

severe lead poisoning
"BAL + EDTA"

156

Meso - 2,3 -Dimercaptosuccinic acid can treat?

moderate lead poisoning
"DMSA"

157

infant w/ hypertonia and hyperreflexia in lower extremities w/ equinovarus deformity - think?

cerebral palsy

158

pellagra?

Deficiency of niacin (B3) --> 3 D's
- Diarrhea
- Dermatitis
- Dementia

159

watery diarrhea + tender rash similar to sunburn + beefy tongue + poor concentration - think?

Pellagra due to niacin (B3) deficiency

160

niacin deficiency can cause?

Pellagra

161

cyanocobalamin is?

vit B12

162

vit B3 is?

niacin

163

vit B6 is?

Pyridoxine

164

vit B2 is?

riboflavin

165

vit B1 is?

Thiamine

166

G6PD deficiency will have what findings on peripheral smear?

Heinz bodies and Bite cells

167

maternal estrogen effects on newborns?

- breast hypertrophy
- swollen labia
- white vaginal discharge (leukorrhea)
- uterine withdrawal bleeding

168

treatment of transplacental maternal estrogen exposure in newborns?

Observation and routine w/ reassurance

169

Mammary gland enlargement + non-purulent vaginal discharge + mild uterine bleeding in newborn -- think?

transplacental maternal estrogen exposure

170

drug for antidepressant effect and smoking cessation?

Bupropion

171

indications for urgent dialysis?

"AEIOU"
Acidosis
Electrolyte abnl
Ingestion
Overload
Uremia

172

pericarditis in a pt w/ renal failure - treat how and why?

- urgent dialysis
- Uremic pericarditis

173

typical paricarditis ECG findings?

- Diffuse concave upwards ST segment elevation
- PR segment depression

174

most common site of ulnar nerve entrapment?

at elbow (medial epicondylar groove)

175

dec sensations at 4th and 5th fingers w/ weak grip think?

ulnar nerve syndrome (compression of nerve)

176

papillary muscle rupture --> what murmur most commonly?

MR