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Medicine > UWorld > Flashcards

UWorld Flashcards

0
Q

What is the long term therapy for patients with Crytococcus meningitis?

A

Fluconazole

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1
Q

Treatment for cyrptococcus meningitis?

A

Amphotericin and Flyucytosine

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2
Q

What are the causes of a pleural effusion?

A
  • Infection
  • Malignancy
  • PE
  • connective tissue disease
  • iatrogenic
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3
Q

Light’s criteria?

A
  1. Fluid to serum protein ration >0.5
  2. Fluid to serum LDH ratio >0.6
  3. Fluid LDH greater than >2/3 upper limit for serum LDH
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4
Q

Enlarged central pulmonary arteries may be a sign of what?

A

Cor Pulmonale

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5
Q

A holosystolic murmur at the L lower sternal border is what?

A

Tricuspid regurg,
May here in cor pulmonale because of pulmonary hypertension, so blood flows back into R ventricle from the pulmonary arteries, during systole (makes sense because this is when blood would enter the pulmonary arteries most forcefully which is what will cause the murmur)

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6
Q

How does cor pulmonale affect P2 heart sound?

A

Louder

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7
Q

What is Beck’s triad?

A

Tamponade: hypotension, elevated JVP, muffled heart sounds

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8
Q

What are the 5 toxicities of amiodarone?

A
  • pulmonary toxicity
  • hepatotoxicity
  • thyroid dysfunction (mostly hypothyroid) (amiodarone has a lot of iodine in it)
  • corneal deposits
  • skin changes
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9
Q

How differentiate viral myocarditis from cardiac tamponade?

A

Both can have recent URI, fatigue, dyspnea and elevated JVP

Myocarditis: typically have pulmonary vascular congestion and audible S3

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10
Q

Track marks, cavitary lesions on lung imaging and h/o IV drug use—Dx?

A

Septic emboli (most likely S. Aureus) from infective endocarditis

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12
Q

Serum calcium correction formula?

A

= measured Ca + 0.8 (4-measured albumin)

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13
Q

pt with HIV with an infection that sounds like UC?

A

CMV

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14
Q

Cause of muscle weakness after and asthma attack?

A

B2 agonist drive K into cells

can cause clinically significant arrhythmias, muscle weakness and EKG changes

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15
Q

ATII preferentially constricts AFF or EFF arteriole?

A

EFF

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16
Q

How does hematuria at the beginning or end of urine stream clue you in to where in the anatomy you may find pathology?

A

Early in stream: urethra

Late: bladder or prostate

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17
Q

Mgmt of pt with acute pancreatitis with a history of gallstones?

A

Cholecystectomy

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18
Q

lethargy, hypogonadism, arthropathy and diabetes are suggestive of what dx?

A

hemochromatosis

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19
Q

Sudden loss of vision and onset of floaters, dx? #1 cause?

A 
vitreous hemorrhage
#1 cause: diabetes
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20
Q

What does factorial design involve?

A

randomization to different interventions with additional study of 2 or more variables

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21
Q

What are the main components of Wegener’s

A
  • systemic vasculitis
  • upper and lower airway granulomatous inflammation
  • glomerulonephritis

*destruction of nasal cartilage and ulcers are common manifestations

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22
Q

Treatment of Wegener’s

A

cyclophosphamide

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23
Q

Labs in Wegener’s

A

C-ANCA

  • RBC casts, proteinuria and sterile pyuria
  • elevated CRP
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24
Q

Ring shaped scaly patches with central clearing and distinct borders - dx?

A

tinea corporis

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25
Q

Citrate in packed RBCs can have what effect on serum electrolytes?

A

can cause hypocalcemia because the citrate can cause the calcium to precipitate

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26
Q

POD 2: hypotension, extensive blood loss into tissues and massive blood replacement Dx?

A

postoperative cholestasis

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27
Q

Pathophys behind postoperative cholestasis?

A

jaundice due to:

  • increased pigment load
  • decreased liver functionality (due to hypotension)
  • decreased renal bilirubin excretion (due to tubular necrosis)
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28
Q

Tx for sinus bradycardia?

A

Atropine

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29
Q

CLL involves what kind of cells?

A

B cells

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30
Q

What is a poor prognostic sign in CLL?

A

thrombocytopenia

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31
Q

kid bit by un-immunized dog, next step?

A

watch dog for 10 days

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32
Q

HTN, palpable bilateral abdominal masses and microhematuria = Dx?

A

ADPKD

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33
Q

common complication of ADPKD?

A

intracranial berry aneurysm, dangerous when coupled with HTN

Also: hepatic cysts, valvular heart disease, colonic diverticula, abdominal wall and inguinal hernia

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34
Q

indinavir side effect?

A

crystal induced nephropathy

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35
Q

didanosine side effect?

A

pancreatitis

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36
Q

Abacavir side effect?

A

hypersensitivity syndrome

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37
Q

NRTIs side effect

A

lactic acidosis

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38
Q

NNRTIs possible side effects?

A

Steven’s Johnson

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39
Q

Nevirapine assoc side effect?

A

liver failure

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40
Q

amenorrhea, absence of vagina and uterus, normal pubic hair and breast development–dx?

A

Mullerian agenesis

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41
Q

Vitamin D Deficiency: what pattern of PTH, ionized calcium and alk phos?

A

elevated iPTH, normal ionized calcium, and elevated alkaline phosphatase.

decreased vit D –> decreased Ca absorption, so increased PTH to maintain free Ca–> increased Alk Phos and bone resorption

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42
Q

Most commonly injured organ in stab wounds?

A

liver

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43
Q

What test is used to confirm a gastrinoma?

A

secretin stimulation test

In this test a fasting gastrin level is measured before administration of intravenous secretin and further samples of serum gastrin are obtained at 2, 5, 10, and 20 minutes after secretin administration. A rise in serum gastrin levels greater than 200 pg/mL above baseline after secretin administration is found in patients with ZES.

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44
Q

Severe pain and urinary retention s/p delivery = dx? mgmt?

A

vaginal hematoma

best treatment is incision and evacuation of the blood clots with ligation of the bleeding vessels if they can be identified

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45
Q

Structural heart defects are typical of what TORCHES infection?

A

Rubella

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46
Q

True or False:
Patients with hepatitis C genotype 2 or 3 are more likely to have a favorable response to treatment with interferon and ribavirin.

A

True

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47
Q

What is Universalization?

A

the awareness that the patient is not alone or unique in his or her suffering and that others share similar symptoms and difficulties, is a powerful healing factor in group therapy.

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48
Q

Ddx for splenomegaly?

A 
Portal HTN (60%)
Myeloproliferative disorders
Leukemia
Lymphoma
Myelofibrosis **
ID
Infectious Mono
AIDS
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49
Q

What do infiltrates do to the liver?

A

Cause it to enlarge

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50
Q

Ddx pneumoperitoneum?

A

outside (trauma or s/p surgery)
inside (perforated DU or colon CA)
infection (emphysematous periotonitis)

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51
Q

Pelvic mass in a male, most likely diagnosis?

A

BPH

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52
Q

large pelvic tumors in women are most likely?

A

mucinous tumors of the ovary

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53
Q

2 major categories that cause dillatation of the stomach/GI tract?

A
  1. mechanical obstruction

2. functional obstruction (adynamic ileus)

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54
Q

DDx long bowel strictures?

A

IBD
ischemia
radiation

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55
Q

Ahaustral colon DDX?

A 
UC
chronic laxative abuse, usually R sided
Bowel proximal to a chronic bowel obstruction 
ischemia
radiation
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56
Q

Thumbprinting cause?

A

focal infiltrations of bowel wall with edema, hemorrhage and/or inflammatory cells

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57
Q

Ddx of thumbprinting

A 
ischemia
diverticulitis
IBD
infection (CMV in AIDS patients)
trauma
anticoagulant therapy
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58
Q

Rigler’s sign?

A

see both sides of the bowel wall because of contrast against intra peritoneal air

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59
Q

Ddx portal venous gas

A

outside: umbilical vein cathterization
inside: bowel infarction
infection emphysematous cholecystitis

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60
Q

Ddx biliary tract air?

A

outside: ext biliary stent
inside: tubular GI tract and biliary fistula
-20 yo - Crohns
-40 yo - Diverticulitis
-60yo - Cancer
Infecction: Emphysematous cholecystitis

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61
Q

What is a varicocele and why do we care about it?

A

dilated extratesticular but intrascrotal vein plexus. Usually caused by defective venous valves. Increases temperature in the scrotum which decreases sperm production.

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62
Q

where should a subclavian line end?

A

tip should be in SVC proximal to atrium

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63
Q

What is the differential diagnosis for mediastinal shift?

A
  • tension pneumothorax
  • unilateral large pleural effusion
  • lung collapse/atelectasis
  • peumonectomy/lobectomy
  • diaphragmatic hernia
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64
Q

What is the differential for mediastinal widening?

A
  1. mediastinal masses (teratoma, lymphoma, metastases)
  2. Hilar lymphadenopathy
  3. Hiatal hernia and other esophageal pathologies (tumor, rupture, dilation)
  4. Aortic pathology (dissection, aneurysm, rupture)
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65
Q

Differential diagnosis of pneumomediastinum?

A

air from outside (iatrogenic, surgery, intubation) (spontaneous trauma, knife or bullet wounds)

  • air from inside: ruptured esophagus, ruptured trachea and/or bronchi, barotrauma, ex. asthma, emesis, parturition
  • gas forming organisms: emphysematous mediastinitis
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66
Q

Treatment for achalasia

A

dilatation

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67
Q

Cause of secondary achalasia?

A

lesion of brain, vagus or esophageal wall that results in failure of relaxation of the LES

DDx: MS, cancer of lower esophagus or gastric fundus, Chagas

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68
Q

how distinguish renal infarcts vs. pyelo on CT?

A

Location of wedges
-in line with calyces: pyelo
=between calyces: infarcts

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69
Q

Extra-renal manifestations of ADPKD?

A 
liver cysts
pancreatic cysts
cardiac valve disorders
hernias
berry aneurysms *HY*
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70
Q

What is the triad of gallstone ileus?

A

pneumobilia (air in the biliary tree), low small bowel obstruction with distended small bowel loops, and an impacted gallstone in the terminal ileum

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71
Q

Ddx for a solitary lung nodule?

A 
Primary lung cancer
solitary mets
rounded pneumonia
pulmonary embolism
granuloma
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72
Q

Ddx for multiple lung nodules?

A

Metastases
Abscesses
Wegener’s granulomatosssssis
Pneumoconioses

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73
Q

What is the differential diagnosis for diffuse osteopenia?

A 
senile osteoporosis
systemic steroids
multiple myeloma
hyperparathyroidism
renal osteodystrophy
rickets
osteogenesis imperfecta
hypophosphatasia
cachexia /malnutrition
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74
Q

what is the difference between subluxation and dislocation?

A

Subluxation: some of the joint is touching
Dislocation: no part of joint is congruous

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75
Q

What are the most common causes of sclerotic bone mets?

A

males - prostate cancer
females - breast cancer
Hodgkin’s lymphoma

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76
Q

Bone pain at night alleviated with aspirin = what dz?

A

osteoid osteoma

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77
Q

psammomatous calcifications are associated with what kinds of cancers?

A

mucinous cystadenocarcinoma of colon and serous? of ovaries

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78
Q

When does the odds ratio approximate the relative risk?

A

when the disease is rare

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79
Q

most common dx in patient with hypercalcemia and elevated PTH?

A

primary hyperparathyroidism

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80
Q

What is the most common source of PE emboli?

A

Deep veins of proximal leg: iliac, femoral and popliteal

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81
Q

afebrile patient with new-onset blood tinged sputum without signs of a more serious disease: treatment?

A

close follow up

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82
Q

branching, filamentous, partially acid fast bacteria?

A

nocardia

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83
Q

tx for nocardia?

A

TMP-SMX

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84
Q

First steps in patient with decreased renal output after surgery?

A

bladder scan or catheterization if the bladder scan is inconclusive (giving fluids could exacerbate overload on kidney)

*post op urinary retention (PUR) is a common complication of surgery and anesthesia

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85
Q

arthritis is characteristic of measles or rubella?

A

rubella (just think rub joints together)

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86
Q

What are the key features of multiple myeloma?

A

C: hyperCalcemia
R: renal failure
A: Anemia
B: lytic bone lesion

MC pres is back pain

Dx: serum electrophoresis

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87
Q

Tx for multiple myeloma

A

Gleevec

hematopoietic cell transplantation

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88
Q

how does lidocaine affect a patient with ST segment elevation in anterior leads and premature beats?

A

increases the risk of asystole, so you do not give prophylactically to prevent V tach

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89
Q

Mgmt of a patient with a large STEMI?

A 
high risk of LV thrombus
increased risk of systemic embolization
-immediate anticoagulation
-vascular surgery eval
-TTE with echo contrast to screen for LV thrombus
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90
Q

How treat diabetic nephropathy?

A

ACEi/ARB and strict glycemic control

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91
Q

what are the main types of diabetic nephropathy?

A

nodular glomerular sclerosis (Kimmelstiel-Wilson syndrome) where there is focal hyaline deposition

diffuse glomerular sclerosis: diffuse hyaline deposition

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92
Q

how treat basal cell carcinoma?

A

Electrodissication and curettage

3-5mm margins

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93
Q

How is DKA managed?

A

restore IV volume with 0.9% saline (normal saline)
correct hyperglycemia with IV Regular insulin
correct electrolyte abnormalities esp. Potassium
Tx precipitating factors like infections with abx

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94
Q

what are symptoms of DKA?

A 
Kussmaul hyperpnea (deep and labored breathing)
abd pain
dehydration
anion gap
low bicarb
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95
Q

What 3 things do you need to dx DKA?

A
  • DM
  • Ketosis (blood and urine ketones)
  • AGMA
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96
Q

What is another name for nitrofurantoin?

A

macrobid

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97
Q

What is the MCC of angioedema?

A

ACE inhibitors

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98
Q

Which blistering skin disorder affects the oral mucosa?

A

pemphigous vulgaris

think pemphigoiD, D for deep

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99
Q

nephrotic syndrome can increase patient’s risk of what?

A

atherosclerosis

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100
Q

what type of anemia is pica associated with?

A

iron deficient, NOT b12

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101
Q

young athlete with episodes of syncope while playing sports, dx?

A

hypertrophic cardiomyopathy
AD
increased muscle and pressure leads to diastolic failure

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102
Q

tx for hypertrophic cardiomyopathy?

A

Beta blockers

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103
Q

What tx in diabetics to decrease end organ damage?

A

ACEi

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104
Q

Tx for SVT with hemodynamic instability

A

Immediate cardioversion

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105
Q

Dx patient with back pain, anemia, renal dysfunction and elevated ESR

A

multiple myeloma

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106
Q

Abx regimen for immunocompromised patients with meningitis?

A

Amp + Vanc + Cefepime

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107
Q

Why DON’T you treat pheochromocytomas with B-blockers?

A

because you can get reflex hypertension

treat with alpha blockers first

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108
Q

what is the first sign of diabetic neuropathy?

A

microalbuminuria

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109
Q

eosinophils in UA indicate what?

A

acute interstitial nephritis

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110
Q

RBC casts are an indicator of what?

A

glomerulonephritis, ischemia or malignant HTN

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111
Q

what do WBC casts indicated?

A

pyelonephritis, tubulointerstitial dz or malignant HTN

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112
Q

What do granular casts indicate?

A

ATN

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113
Q

what do broad waxy casts indicated

A

chronic renal failure with dilated ducts

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114
Q

what do fatty casts indicate

A

nephrotic syndrome

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115
Q

what do hyaline casts indicate?

A

nonspecific

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116
Q

How treat PCN allergic syphylis?

A

Doxy or Ceph in non-pregnant pts

PCN desensitization and PCN in pregnant patients

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117
Q

What type of drug abuse leads to gynecomastia and erythrocytosis?

A

steroid drug abuse (includes androgens)

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118
Q

appropriate initial therapy/mgmt for patient with concern for MI?

A
  • ASA
  • EKG
  • Troponins
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119
Q

What do you do if CKMB and trops are negative in a pt with a high suspicion of MI?

A

repeat at 6 and 12 hours

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120
Q

How treat patient with acute chest pain ongoing unstable angina?

A
  • beta blocker to decreased O2 demand
  • ASA
  • heparin
  • angiography
  • Statin
  • sublingual nitro
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121
Q

HOw distinguish aortic dissection vs. cardiac tamponade

A

cardiac tamponade will have elevated JVP and pulsus paradoxus (variation in systolic BP related to breathing)

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122
Q

What is Beck’s traid for Cardiac tamponade?

A

hypotension JVD and muffled heart sounds

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123
Q

what is dx gold standard for cardiac tamponade?

A

echo

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124
Q

what is more important in tamponade: rate or amt?

A

rate. bc pericardium can stretch

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125
Q

mainstay of tx for kidney stones?

A

rehydration

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126
Q

Dx test when suspicious of choriocarcinoma?

A

quantitative b-hcg

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127
Q

CHADS2 risk score what counts for each thing?

A 
CHF
Hypertension
Age > 75
DM
Prior Stroke or TIA
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128
Q

Tx for CHADS 0, 1 or >2

A

0: nothing or ASA
1: Anticoag or ASA
2: anticoag

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129
Q

what is triad asthma?

A
  • asthma
  • aspiring sensitivity
  • nasal polyps
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130
Q

what is the treatment for histo/blasto/coccidio

A

itraconazole

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131
Q

tx for uric acid kidney stones?

A

ppx allopurinol

tx potassium citrate

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132
Q

stone tx for stones up to 0.5cm-2cm or greater than 2cm?

A

0.5 to 2: shockwave lithotripsy

>2: percutaneous nephrostomy

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133
Q

MCC chronic bronchitis

A

smoking

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134
Q

tx for hepatic encephalopathy

A

lactulose (decreases urea absorption)

neomycin (kills GI flora that make urea)

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135
Q

MCC secondary clubbing?

A
  • lung cancer
  • CF
  • R to L cardiac shunts
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136
Q

tx for postnasal drip?

A

anti-histamine +/- pseudoephedrine

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137
Q

tx for actinomycosis israeli?

A

high dose PCN

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138
Q

tx for nocardia

A

TMP-SMX

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139
Q

how does compliance change in ARDS?

A

decreases (stiff lungs)

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140
Q

tx cat-scratch dz

A

azithromycin

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141
Q

tx for pt with heavy alcohol use, MCV 101 and CHF that will REVERSE dz process?

A

stop using alcohol

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142
Q

MGMT pt with FAP

A

total proctocolectomy

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143
Q

tx paroxysmal SVT

A

vagal maneuvers or IV adenosine

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144
Q

tx a fib

A

control rate with beta-blocker, DV cardioversion, anticoagulation

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145
Q

tx v tach

A

IV amiodarone if stable, if not, DC cardioversion

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146
Q

tx v fib

A

immediate defibrillation and CPR

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147
Q

What is the CSF picture like for herpes encephalitis?

A

elevatd WBC, lymphs, normal glucose, elevated protein concentration

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148
Q

elevatd WBC, lymphs, normal glucose, elevated protein concentration

A

Herpes encephalitis

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149
Q

ringed sideroblasts, severe anemia in elderly dx?

A

myelodysplastic syndrome

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150
Q

Treatment for chronic Hep B?

A

Tenofovir

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151
Q

Sx similar to CHF with rapid onset and s3 dx?

A

viral myocarditis

typically due to coxsackie b

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152
Q

Young pt with decreased K, HTN refractory to meds, dx?

A

primary hyperaldosteronism

dx: abd CT scan

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153
Q

threshold for resecting adrenal incidentaloma?

A

> 5cm

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154
Q

Ectopic cushing syndrome can be due to what underlying illness?

A

SCLC

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155
Q

5 P’s of pheochromocytoma?

A

pressure, pain (HA), prespiration, palpitations, pallor

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156
Q

what type of drug is fludrocortisone?

A

mineral corticoid

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157
Q

Tx Addison’s

A

mineralcorticoid: fludrocortisone and glucocorticoid: prednisone

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158
Q

MCC 2o adrenal insufficiency

A

abrupt cessation of steroids

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159
Q

what labs are suggestive of primary hyperaldosteronism

A

plasma aldosterone: renin >20, aldo >15

160
Q

tx for DKA?

A

insulin, potassium, IVF (NS)

161
Q

cryoglobulinemia assoc w/?

A

Hep C

162
Q

Dacrolytis

A

inflammation of lacrimal sac

163
Q

tx for constrictive pericarditis

A

pericardiectomy

164
Q

increase in systemic venous pressure, edema, ascites, hepatic congestion, JVD, pericardial knock, Kussmaul sign–Dx?

A

constrictive pericarditis

165
Q

Bug that can cause osteomyelitis in a puncture wound?

A

pseudomonas

166
Q

prevention of meniere’s disease

A

low salt diet, low alcohol, caffeine and nicotine

167
Q

what glomerular dz is associated with hodgkin’s lymphoma?

A

minimal change dz

168
Q

how to decrease risk of contrast induced kidney injury in a patient with decreased renal function?

A

non ionic contrast

169
Q

pt’s with PAD and intermittent claudication are at risk of what?

A

MI 20% over 5 years

~20% risk of death due to CVD over 5 years

170
Q

decrescendo early diastolic murmur

A

AR

171
Q

2 common causes of pulsus paradoxus

A

cardiac tamponade, COPD

172
Q

common side effects of niacin

A

flushing and itching

173
Q

what are the 5 Hs and 5 Ts of PEA?

A 
hypovolemia
hypo/per kalemia
hypoxia
H ions
hypothermia
Tension PTX
tamponade
toxins
thrombosis 
trauma
174
Q

what effect does dipyrimadole have in pharmacologic stress testing?

A

increases cardiac steal so can highlight areas of ischemia on exertion

175
Q

what is a PVC? tx?

A

wide QRS without a preceding p wave

-reassurance unless recurrent with underlying heart dz–> implantable defib

176
Q

aliskiren is what kind of drug?

A

direct renin inhibitor

177
Q

high-pitched systolic murmur at second R intercostal space–> what could cause chest pain

A

AS in young person due to bicuspid valves–> increased O2 demand because of hypertrophy 2/2 bicuspid valve

178
Q

1st line tx for stable, chronic angina

A

metoprolol, beta blocekr

179
Q

what non-pharmacologic intervention will have the biggest impact on decreasing BP

A
  1. weight loss

2. DASH diet

180
Q

what is associated with an increased rate of AAA expansion and rupture

A

ciagarette smoking

181
Q

assoc/RFs for

  • ascending aortic aneurysms
  • descending aortic aneurysms
A

ascending: cystic medial necrosis or connective tissue disorder
descending: atherosclerosis

182
Q

Do premature atrial beats require treatment?

A

NO, they are completely benign

183
Q

What type of glomerular dz is associated with HIV?

A

FSGS

184
Q

One test for histoplasmosis?

A

urine antigen testing

185
Q

leading cause of death in acromegaly?

A

congestive cardiac failure

186
Q

jewish woman with a black liver and increased conjugated bilirubin = ?

A

dubin-johnson

187
Q

When is MMR vaccine contraindicated in HIV patients?

A

if CD4 <200

188
Q

hexagonal renal stones = ?

A

cystine stones
dx urinary sodium nitroprusside test
tx acetazolamide

189
Q

Dx imaging test for kidney stones

A

non con CT

190
Q

severe abdominal pain with syncope followed by abdominal discomfort dx

A

ruptured AAA

191
Q

diarrhea and tenesmus s/p radiation: next step mgmt

A

likely radiation proctitis

Flex Sig is next test, looking for mucosal telangiectasia

192
Q

workup HUS

A

peripheral blood smear, looking for schistocytes

193
Q

IBS like sx with mostly diarrhea–dx?

A

IBS!

194
Q

Tx for salmonella gastroenteritis

A

no Abx

195
Q

increased AST, ALT, slightly elevated alk phos, increased direct bilirubin –what pattern of injury?

A

hepatocellular

196
Q

adult with elevated indirect bilirubin and no symptoms, dx?

A

Gilbert syndrome

197
Q

if US doesn’t show a gallstone in the CBD does that mean one isn’t there?

A

NO!!
can still have them. If you suspect it’s there and see dilatation of the CBD, then even if you don’t see it on US you manage pt as if it’s there

198
Q

MGMT of edematous, severe pancreatitis

A

enteral nutrition via NJ tube

199
Q

Tx for IBS diarrhea?

A

loperamide

200
Q

how should patients with Hep B be screened for HCC?

A

US

201
Q

treatment for esophageal varices in cirrhotics?

A

prophylactic beta blocker

202
Q

What liver/GI lab elevations can OCPs cause

A

direct bilirubin, alk phos

203
Q

new cirrhotic, next step intervention?

A

esophageal scope to look for varices

204
Q

Zenker’s workup

A

contrast esophogram

205
Q

suspect achalasia, after barium swallow next step?

A

endoscopy to r/o cancer

206
Q

esophageal perf workup?

A

gastrograffin contrast esophagraphy

207
Q

cause of gallstones in pts on TPN?

A

gallbladder stasis

208
Q

67 yo pt with nausea vomiting, diffuse abdominal pain, decreased bowel sounds, elevated amylase
Dx?

A

acute mesenteric ischemia

amylase can be elevated

209
Q

pt with 5 month history of episodic retrosternal pain, radiates to intrascapular area, precipitated by hot/cold food and emotional stress, regurgitates food intermittently, cardiac testing negative, CXR normal, normal EGD, next step and dx?

A

next step: motility studies (manometry)

dx: diffuse esophageal spasm

210
Q

brown discoloration of colon with white lymph follicles in a patient with profuse watery diarrhea

A

laxative abuse aka factitious diarrhea

211
Q

45yo man with h/o PUD, 3 duodenal ulcers, upper jejunal ulceration and prominent gastric folds on EGD, nex step?

A

serum gastrin concentration to r/o Zollinger Ellison

212
Q

if IgA testing for celiac is negative can a patient still have the disease?

A

yes because many people with celiac have an IgA deficiency and in that case will test negative

213
Q

Diarrhea in an AIDS patient?

A

cryptosporidium (acid fast staining)

214
Q

what are the 2 watershed areas of the colon

A

splenic flexure and recto-sigmoid junction

215
Q

traveler with malabsorptive sx, dx? tx?

A

Giardia
pathophys: forms adhesive discs
Tx: Flagyl

216
Q

best long-term symptom relief tx in patients with PUD?

A

Abx and PPIs since H Pylori is the #1 cause (not vagotomy)

217
Q

lactose intolerance test

A

hydrogen breath test, indicates bacterial carbohydrate metabolism

218
Q

what dx should you consider in patients with regional pain and no evidence of dz of internal organs?

A

zoster

219
Q

what phases of alcoholic hepatitis can be reversed if the patient stops drinking?

A

ALL OF THEM

220
Q

AIDS pt with malaise, B sx, elevated alk phos, splenomegaly: Dx? Tx?

A

disseminated mycobacterium avium complex
dx w/blood cultures
tx: clarithromycin or azithromycin
*pts with CD4<50 should be on Azithro prophylaxis

221
Q

Pt with symptoms suspicious for MEN2A, next test?

A

dx pheo
plasma free metanephrines or 24 hr urine metanephrines
Definitive test : ret proto-oncogene

222
Q

Pt with a thyroid mass, first step in workup?

A

TSH and thyroid US

223
Q

Pt with hypothyroid sx, nml TSH and elevated T3 and T4, dx?

A

resistance to thyroid hormones, receptor deficits on peripheral tissues

224
Q

Pt with decreased TSH, increased T3/T4 and diffusely decreased radioisotope–dx?

A

factitious thyrotoxicosis

225
Q

MC side effect of radioactive iodine tx?

A

hypothyroidism

226
Q

DDx of a patient who presents with hypokalemia, alkalosis and normotension?

A

diuretics
surrupticious vomiting
Barrter’s
Gitelman’s

227
Q

constipation, ab pain, polyuria and polydipsia

dx?

A

hypercalcemia

228
Q

1st step in management of DI in a symptomatic patient?

A

normal saline to fluid resuscitate

THEN hypotonic D5W

229
Q

In a patient on levothyroxine, how will taking estrogen affect their thyroid therapy?

A

estrogen will lead to an increase in TBG, so the patient will have to increase their dose of L-thyroxine

230
Q

what is the MC type of thyroid cancer?

A

papillary

231
Q

what is the best way to screen of MEN2?

A

DNA testing since it’s associated with a GERMLINE mutation in the ret oncogene

patients who test positive should have a prophylactic thyroidectomy

232
Q

pts with untreated hyperthyroidism are at risk for what?

A

rapid bone loss

233
Q

What are some common and endocrine causes of SIADH?

A

NSAIDs

hypothyroidism and adrenal insufficiency

234
Q

pt with increased Ca, decreased Phos and increased PTH, high urine ca, and high Ca/Cr clearance—best next step?

A

refer for surgery

235
Q

pt presents with rapid onset hirsuitism and virilization

–next best step?

A

measure serum testosterone and DHEAS

236
Q

pt with throat pain and fever s/p PTU—dx?

A

agranulocytosis, stop PTU

237
Q

marfanoid habitus assoc with which MEN type?

A

2B

238
Q

mexican pt with sx of adrenal insufficiency, bilateral adrenal calcs–dx?

A

TB

239
Q

1st line test for suspected adrenal insufficiency

A

250ug cosyntropin stimulation test with cortisol and ACTH levels

240
Q

best 1st test for ED

A

nocturnal penile tumescence

241
Q

tx pagets

A

bisphosphonates

242
Q

35 yo man with bilateral gynecomastia, decreased LH and FSH, increased estrogen and testosterone, negative hcg and AFP— Dx?

A

Leydig cell tumor

243
Q

best first test dx acromegaly

A 
IGF levels (elevated whole day, growth hormone levels fluctuate)
if high, do OGTT
244
Q

pt with HTN and undetectable renin, dx?

A

primary hyperaldosteronemia

245
Q

should risperdol affect pituitary thyroid axis?

A

No

246
Q

what is the cause of 80% of malignancy induced hypercalcemia?

A

PTHrP

247
Q

avoid loop diuretics in calcium overload status unless ______________

A

volume overload present

248
Q

treatment for androgen excess in PCOS

A

combined hormonal pills

249
Q

what is the cause of a hydatid cyst?

A

echinococcus granulosus

250
Q

what is the mainstay of treatment in primary biliary cirrhosis?

A

ursodeoxycholic acid

251
Q

pt on diuretics who develops hepatic encephalopathy, found to have hypokalemia, next step in mgmt?

A

give K

252
Q

pt with hep c, being considered for treatment, next step?

A

biopsy

253
Q

alcoholic hepatitis: lab pattern?

A

2:1 ratio of AST to ALT

elevated Ferritin and GGT

254
Q

test of choice for achalasia

A

manometry

255
Q

est of choice for GERD

A

24hr pH monitoring

256
Q

esophageal DDx for an HIV pt with CD <100

A

candida
CMV
HSV
esophagitis

257
Q 
MCC iron deficiency in 
kids
women
men
elderly
A

kids: meckel diverticulum
women: menorrhagia
men: peptic ulcers
elderly: colon cancer

258
Q

goal INR prosthetic valve

A

2.5 to 3.5

259
Q

what marker of Hep B infection is present during the window period?

A

IgM anti-HBc

260
Q

how does cirrhosis effect total T3 and T4 levels?

A

decreases total T3 and T4 levels because of decreased liver synthesis of serum binding proteins for T3 and T4, however, the free concentration of T3 and T4 is unchanged

261
Q

best lab test to use for follow up of chronic Hep B infection?

A

serial ALT and HBeAg

262
Q

MCC macrocytic anemia in pt with sickle cell

A

folate deficiency

263
Q

SIADH is most commonly associated with what cancer?

A

small cell lung cancer

264
Q

mainstay of treatment of MALT lymphoma

A

antibiotics

most associated with h pylori

265
Q

treatment of a solid testicular mass

A

orchiectomy: removal fo testis and cord

266
Q

paget’s disease of the breast associated with what type of cancer?

A

adeno

267
Q

chondrocalcinosis associated with what conditions

A

pseudogout
hemochromatosis
hyperparathyroidism
hypomagnesemia

268
Q

MCC iron deficiency anemia worldwide

A

hookworms

269
Q

treatment for aplastic anemia

A

antithymocyte globulin, cyclosporine, marrow transplant if refractory

270
Q

tx TTP

A

plasma exchange

271
Q

tx HUS

A

dialysis

272
Q

tx ITP

A

steroids, IVIG, splenectomy, rituximab for refractory dz

273
Q

patients who have HIT-2 are at risk of developing what?

A

thrombus

274
Q

tx for spinal cord compression (decreased sphincter tone and DTRs)

A

steroids! can see in prostate cancer, etc.

275
Q

treatment for cancer associated cachexia?

A

progesterone analogs or glucocorticoids

276
Q

elevated WBCs and thrombocytosis, ddx

A

myeloproliferative neoplasm

277
Q

rash and new-onset diabetes that doesn’t require tx

A

glucagonoma

278
Q

peripheral lung lesion with gynecomastia and galactorrhea dx?

A

large cell lung cancer

279
Q

what is the initial drug of choice for hypercalcemia of malignancy?

A

bisphosphonates aka zolendronic acid

280
Q

Hypercalcemia, epigastric abdominal pain with occult bleed

dx?

A

MEN1
primary hyperPTH
gastrin-producing tumor

281
Q

Tamoxifen use can cause an increased risk of what cancer?

A

endometrial

282
Q

what drugs can cause mild megaloblastic anemia?

A

phenytoin
primidone
phenobarbital
–> impaired absorption of folic acid

283
Q

pt with sx of microcytic anemia, decreased concentration, insomnia and muscle pain

A

lead poisoning

284
Q

what is a diagnostic hallmark of lupus anticoagulant?

A

elevated PTT

285
Q

before treat with trastuzumab and chemo, what test?

A

EKG

combined can cause cardiac toxicity

286
Q

what cancer can pernicious anemia cause?

A

gastric

287
Q

treatment of hyperkalemia in a patient with renal failure?

A

furosemide with saline infusion

288
Q

an infection in what neck space can spread to the mediastinum?

A

retropharyngeal

289
Q

white granular patch or plaque over the buccal mucosa in patients with a history of alcohol and tobacco

A

leukoplakia

can progress to squamous cell carcinoma

290
Q

what drugs can cause ototoxicity

A

loop diuretics
aminoglycosides
salicylates
cisplatin

291
Q

what is a contraindication to succinylcholine administration?

A

hyperkalemia

292
Q

treatment for pt with 4 weeks of foul smelling stools s/p trip?

A

Giardia so give FLAGYL

293
Q

low urinary Cl in a patient with metabolic alkalosis is suggestive of what?

A

vomiting or prior diuretic use as cause of metabolic alkalosis

294
Q

mgmt of post-ictal lactic acidosis?

A

observe and repeat labs in 2 hours

295
Q

pt with cocaine use and chest pain, mgmt of chest pain

A

diazepam

296
Q

common complication of GCA?

A

aortic aneurysm

297
Q

bone pain, renal failure and hypercalcemia = Dx?

A

multiple myeloma

298
Q

immediate tx of central retinal artery occlusion?

A

ocular massage and high flow O2

299
Q

eye dz that causes straight lines to appear bent and wavy?

A

macular degeneration

300
Q

cause of presbyopia

A

decreased lens elasticity

301
Q

what is a stye? tx?

A

staph abscess of lid

responds to warm compress of eyelid

302
Q

tx for a patient with wolff parkinson white?

A

procainamide

303
Q

first line tx HOCM

A

Beta blockers

304
Q

Niacin side effects due to what

A

prostaglandin mediated vasodilation

305
Q

tx Prinzmetals

A

nitrates or CCBs to block vasoconstriction

306
Q

fatigue, constipation, weight gain, dry skin, forgetfulness or other neuro signs are side effects of what drug

A

Amiodarone

Used for ventricular arrhythmias and rhythm control in pts with AFib and underlying LV systolic dysfunction

307
Q

risk of untreated hyperthyroidism

A

rapid bone loss

308
Q

MCC HTN with low renin

A

hyperaldosteronism

309
Q

how dx factitious thyrotoxicosis

A

low serum thyroglobulin levels

310
Q

renal vein thrombosis is most commonly associated with what glomerulonephritis

A

membranous

311
Q

aside from increasing fluid intake, what medication is recommended to patients who have recurring kidney stones

A

thiazides

312
Q

why might someone have difficulty urinating after taking diphenhydramine?

A

detrusor inactivity

313
Q

is normal saline a crystalloid or colloid?

A

crystalloid

314
Q

patients with Afib and what comorbidity are started on digoxin?

A

CHF

315
Q

how treat TB meningitis

A

RIPE and steroids

316
Q

Dx meningitis

A

gram stain > 1000 WBCs

317
Q

common extra-pulm manifestation of mycoplasma pneumonia

A

rash

318
Q

tx for tularemia pneumonia

A

streptamycin or gent

319
Q

tx for lung abscess?

A

amp-sulbactam

320
Q

when give oseltamivir

A

only if within 48 hours of symptom onset

321
Q

next step, pt with + PPD and CXR

A

acid fast stain of sputum

322
Q

TB drug side effects

RIPE?

A

oRifampin→ turns everything RED, CYP450 inducer
oINH→ B6 vitamin deficiency, sideroblastic anemia, peripheral neuropathy
oPyrazinamide→benign hyperuricemia
oEthambutol→ optic neuritis or color vision abnormalities

323
Q

MCC meningitis in HIV patients

A

s pneumo

324
Q

MCC pneumonia in HIV patients

A

S. pneumo

325
Q

treatment for Bartonella

A

oral azithro

326
Q

patient with recent nasal packing, presents with confusion, nausea, hypotension and febrile, dx?

A

TSS

327
Q

halo or air crescent sign on chest imaging is associated with what bug?

A

aspergillus

328
Q

subacute meningitis in HIV pt?

A

cryptococcus

329
Q

HIV patient with clear oropharynx and odynophagia, dx?

A

viral: CMV or HSV

330
Q

best first screening test for HIV

A

p24 antigen and antibody testing

331
Q

how dx histo?

tx?

A

urine antigen

tx itraconazole

332
Q

tx of symptomatic sinus bradycardia

A

atropine

then pacing

333
Q

when use digitalis?

A

Diastolic CHF, pts with Afib with RVR

334
Q

mixed venous O2 sat is elevated in what type of shock

A

septic
hyperdynamic circulation, improper distribution of cardiac output and inability of the tissues to adequately extract oxygen

335
Q

hemochromatosis causes what cardiac effects?

A

cardiac conduction abnormalities

336
Q

how does cold water therapy treat SVT?

A

affects AV node conductivity and re-entry

337
Q

two common causes of hemorrhagic pleural effusion?

A

PE and malignancy

338
Q

if you suspect ankylosing spondylitis, best first test?

A

x ray of lumbar spine

339
Q

SLE with renal sx, best first test

A

renal bx

340
Q

treatment for fibromyalgia

A

amytriptyline

341
Q

tx for dermatitis herpetiformis

A

dapsone

342
Q

Pt with positive PPD, negative chest xray, next step?

A

INH for 9 months

343
Q

acute migriane tx

A

prochlorperazine

344
Q

guillain barre tx?

A

IVIG or plasmapheresis

345
Q

dx carcinoid syndrome?

A

urine 5-HIAA

346
Q

how dx gallbladder cancer?

A

abdominal CT

347
Q

how dx cholangiocarcinoma

A

ERCP since it’s a tumor of the bile ducts

348
Q

tx liver failure patients with a bleed

A

FFP because they cannot synthesize clotting factors

349
Q

first step in unstable upper GI bleed

A

intubate

350
Q

mgmt if suspect variceal hemorrhage

A

volume resuscitation, IV octreotide, abx

351
Q

watery diarrhea, muscle weakness and hypo/achlorhydria, also have facial flushing/lethargy/N/V are all signs of what dx?

A

VIPoma
can have co-existing hyperPTH as part of MEN

Dx: VIP level >75, often mets to liver

352
Q

all patients with hep c should have what immunization?

A

Hep A

353
Q

preferred tx for chronic Hep B?

A

TEnofavir and Entecavir

less drug resistance, can be used in decompensated cirrhosis

354
Q

MCV 60 and target cells, dx

A

thalassemia

355
Q

superficial thrombophlebitis, palpable venous cord, next step

A

CT abdomen

assoc with pancreatic cancer

356
Q

what type of drug is zofran?

A

serotonin antagonist

357
Q

increased leukocyte alk phos score suggests what

A

leukemoid reaction, 2/2 severe inflammation or infection

358
Q

altered mental status + fever + MAHA dx

A

TTP

359
Q

treatment for TTP or HUS

A

plasmapheresis emergently

360
Q

SIADH is associated with what lung cancer?

A

small cell

361
Q

spherocytes without central pallor are seen in what illnesses?

A

spherocytosis and AIHA

362
Q

tx warm agglutinins

A

steroids, splenectomy if refractory

363
Q

tx cold agglutinins

A

avoid cold weather, rituximab

364
Q

DM, necrolytic migratory erythema, weight loss, diarrhea and anemia dx?

A

glucagonoma

365
Q

older pt with difficulty hearing in noisy environments, dx

A

presbycusis

366
Q

mgmt of a patient with a single brain met

A

surgical removal

367
Q

mgmt acute acetaminophen tox

A

charcoal if

368
Q

MC electrolyte abnormality in patients with Cushing’s

A

hypokalemia

369
Q

Gi sx in patients with A Fib dx?

A

Digoxin toxicity

370
Q

hypertensive pt on meds who drinks a lot, next step in HTN mgmt?

A

counsel on drinking less

371
Q

how does valsalva impact LV preload

A

decreases it

372
Q

how treat beta blocker overdose?

A

glucagon

373
Q

how treat beta blocker overdose?

A

glucagon

374
Q

what types of arrhythmias are common in the first 10 mins s/p MI and in the first 10-60 mins?

A

0-10 min: reentrant

10-60 mins: impaired automaticity

375
Q

what types of arrhythmias are common in the first 10 mins s/p MI and in the first 10-60 mins?

A

0-10 min: reentrant

10-60 mins: impaired automaticity

376
Q

atrial tachycardia with AV block is specific for what?

A

digoxin toxicity

377
Q

inheritance pattern of HOCM?

A

AD

378
Q

Foci of Atrial fibrillation?

A

pulmonary veins

379
Q

Foci of Atrial fibrillation?

A

pulmonary veins

380
Q

how treat PVCs?

A

no sx: no tx

sx: BB

381
Q

pregnant woman at 25 weeks with history of hep C, next step

A

immunize against Hep A and B

382
Q

who needs menigococcal vaccine booster

A

16-21yo who had shot before age 16

383
Q

what vaccines are contraindicated in pts with CD4 count

A

VZV, MMR, live flu

384
Q

what HIV med turns urine red

A

indinavir bc causes crystal nephropathy

385
Q

sounds like RA but started 10 days ago, dx?

A

Parvo B19

386
Q

side effect of hydroxychloroquine

A

retinopathy

387
Q

crampy pain, parasthesieas and carpopedal spasm are signs of what electrolyte abnormality

A

hypocalcemia

388
Q

what acid base disorder causes hypocalcemia

A

alkalosis, ex. resp 2/2 hyperventilation

increased pH–> increased affinity of Ca for albumin, leads to a decrease in ionized calcium

389
Q

pt with BPH symptoms and AKI, next step?

A

renal US

390
Q

persistent ST elevation 1-2 months s/p MI with Q waves in same leads dx?

A

ventricular aneurysm

391
Q

hypogonadism, arthropathy, diabetes and hepatomegaly

A

hemochromatosis

cardiac conduction abnormalities

392
Q

recurrent chalazion mgmt

A

histopath eval to r/o cancer

393
Q

how dx Wernicke’s vs. B12 deficiency

A

Wernickes: gait instability, AMS and nystagmus and conjugate gaze palsy, which you do not see in B12 deficiency

394
Q

hashimoto’s causes an increased risk of what thryoid cancer?

A

lymphoma

395
Q

young Asian woman with absent pulses and asymmetrical BP dx? tx?

A

Takayasu’s
Dx: ateriogram
Tx: steroids, angioplasty for stenosed vx

396
Q

Dx and Tx for PAN

A

dx: tissue bx, increase P anca
tx: steroids

397
Q

asthma, eosinophilia and granulomatous vasculitis

dx? tx?

A

dx: churgg strauss, p-anca
tx: steroids

Medicine (8 decks)

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