UWORLD 6 Flashcards

Question

Granulomatous disorders can cause hypercalemia due to what?

Answer 1

**Granulomatous disorders (**ex: sarcoidosis, tuberculosis) can cause hypercalemia due to **extrarenal production of 1,25 dihydroxyvitamin D.**

Answer 2

**throbbing, headache, nausea, malaise, and dizziness** Several people simultaneously presenting with a **headache** is an important clue. Diagnosis is confirmed by **carboxyhemoglobin** **level** **measurement**.

Answer 3

**Stimulant medications** are a first-line treatment for **adolescents or school-aged children (age \> or =6)** and include mehylphendiate and amphetamines **Preschool child (age \<6)**, then **behavioral therapy** would be first line option. \*Stimulant therapy for ADHD does not increase risk of developing a substance use disorder

Answer 4

**Iritis** **pain, redness, variable visual loss and constricted and irregular pupil.** Visualize the anterior segment of the eye with **slit lamp examination** - If **leukocytes are seen in the anterior segment,** which contains aqueous humor found between the corenea and the lens, then the diagnosis of iriritis is confirmed. A **havy "flare"** which is indicative of **protein accumulation** secondary to a damaged blood aqueous barrier, may also be seen

Answer 5

Uveitis is inflammation inside the eye, specifically affecting one or more of the three parts of the eye that make up the uvea: - the **iris** (the colored part of the eye), - the **ciliary body** (behind the iris, responsible for manufacturing the fluid inside the eye) and - the **choroid** (the vascular lining tissue underneath the retina). _Anterior uveitis:_ Inflammation in the front (anterior) part of the eye, in the area **between the cornea and the iris.** This inflammation derives primarily from **inflammation of the iris.** _Intermediate uveitis_: A term used to denote an idiopathic inflammatory syndrome mainly involving the **anterior vitreous, peripheral retina, and ciliary body,** with minimal or no anterior segment or chorioretinal inflammatory signs _Posterior uveitis_: Inflammation predominately located in the posterior vitreous, retina, and/or choroid. Posterior uveitis is a vision disorder characterized by **inflammation of the layer of blood vessels underlying the retina, and usually of the retina as well.**

Answer 6

**Around 12 monhts**, but is considered **normal at age 9-16 months.** Considered if a **child is not walking by 16 months** OR **delays are present in multiple development categories.**

Answer 7

**X-linked disorder** characterized by **proximal muscle weakness and cardiomyopathy.** Although **delayed** **walking** can be a **presenting** sign, **almost all patients** also have **cognitive** **delays**. Screening with a **creatine kinase level,** which is **elevated** in this condition

Answer 8

Conjunctivitis is a diagnosis of exclusion and is made in a patient with red eye and discharge only if vision is normal and there is no evidence of glaucoma, iritis or keratitis.

Answer 9

Infectious keratitis (inflammation of the cornea) is characterized by **severe photophobia and difficulty keeping the affected eye open.** **Penlight examination** reveals corneal opacitiy or infiltrate

Answer 10

\> or = 3 days and \< or = 1 month following exposure to the traumatic event. PTSD is \> 1 month

Answer 11

**Depends on the number, size and type of polyps.** Small rectal hyperplastic polyps - **10 years** 1 or 2, small **(\<1 cm)** tubular adenomas - **5 years** \> or = 3 polyps, **any polyps \> 1cm,** villous adenoma with high grade dysplasia features - **3 years** **Very large polyps (\>2 cm) or carcinoma in-situ** - **2 to 6 months** to verify complete excision. Patients with **familal adenomatous polyposis** are at especially high risk and should have **annual colonscopy.**

Answer 12

**bronchogenic carcinoma** **Flexible bronchoscopy** for the confirmation of the diagnosis. This is an **simple, invasive test** that will enable the physican to visualize the actual endobronchial lesion, and take a tissue biopsy at the same time.

Answer 13

Lung, breast, unknown primary, melanoma and colon cancer.

Answer 14

Smoking, excessive alcohol intake (\> 3 drinks/day), sedentary lifestyle

Answer 15

**Physican directed counseling** should be recommended for smoking cessation during pregnancy. Other than counseling, it is not clear how best to treat pregnant smokers. In the event that patient fail to stop smoking or do not respond to behavioral therpy, **nicotine replacement therapy or buproprion** can be considered after an **informed discussion of the benefits and risks.**

Answer 16

**PHP** - *PHP Resistance of PTH on its target tissue* _Calcium_: LOW, _Phosphate_: HIGH, _PTH_: HIGH, _25-OHD_: Normal **Hypoparathyroid**: _Calcium_: LOW, _Phosphate_: HIGH, _PTH_: LOW, _25-OHD_: Normal **Vitamin D Deficiency**: _Calcium_: LOW, _Phosphate_: LOW, _PTH_: HIGH, _25-OHD_: LOW

Answer 17

**TYPE 1A-** has features of **Albright Hereditary Osteodystrophy** in addition to hypoparathyroidism. **Hypocaclemia with Hyperphosphatemia** (as evidenced by bilateral cateracts and calification of his basal ganglia - Fahr's syndrome) **Short stature, round face, short fourth and fifth metacarpels and a short neck.** **TYPE 1B** - do not have features of AHO **PPHP** (pesudopseudohypoparathodism) do not have hypocalemia and hypercalemia because the resistance to PTH is mild, but they do have AHO.

Answer 18

**Accuracy** = (TP + TN) / TP+FP+TN+FN

Answer 19

**TYPE 1A-** has features of **Albright Hereditary Osteodystrophy** in addition to hypoparathyroidism. **Hypocaclemia with Hyperphosphatemia** (as evidenced by bilateral cateracts and calification of his basal ganglia - Fahr's syndrome) **Short stature, round face, short fourth and fifth metacarpels and a short neck.** **TYPE 1B** - do not have features of AHO **PPHP** (pesudopseudohypoparathodism) do not have hypocalemia and hypercalemia because the resistance to PTH is mild, but they do have AHO.

Answer 20

**Accuracy** = (TP + TN) / TP+FP+TN+FN

Answer 21

**PHP** - *PHP Resistance of PTH on its target tissue* _Calcium_: LOW, _Phosphate_: HIGH, _PTH_: HIGH, _25-OHD_: Normal **Hypoparathyroid**: _Calcium_: LOW, _Phosphate_: HIGH, _PTH_: LOW, _25-OHD_: Normal **Vitamin D Deficiency**: _Calcium_: LOW, _Phosphate_: LOW, _PTH_: HIGH, _25-OHD_: LOW

Answer 22

A **low dose suppression test** Cushing's can be a **secondary cause of hypertension**. patient would have **obesity, muscle weakness, hyperpigmentation, brusing, or other Cushingoid features.**

Answer 23

Likelihood of an **event occuring the treatment group relative to the control** group. **Measure of effect** used in **survival analysis (or time to event analysis)** **Null value for HR is 1.0,** which means there is **no difference in risk** between the two groups. **HR \<1.0 = protective effect** *(event less likely to occur in the treatment group than the control group)* **HR \>1.0 indicates a detrimental effect** *(event more likely to occur in the treatment group than the control group)*

Answer 24

**Pulmonary function testing (PFT)** Patients with **active** **symptoms** at the **time of testing** should reveal the characteristic **obstructive** pattern consistening of a **reduced FEV1** and a **reduced FEV1/FVC ratio** (total lung capacity and difffusing capacity of the lungs for carbon monoxid (DLCO) are typically normal or sometimes elevated). In these patients, a **bronchodilator** (ex: albuterol) can be administered and should result in **signifcant improvement in FEV1** (ex: 15% from baseline) Those without active symptoms: are likely to have **normal PFT findings.** The administration of **methacholine** in these patients is likely to cause \> or =**20% reduction in FEV1,** which is **diagnostic of airway hyperresponsiveness.** Most patients with asthma have a **positive methacholine challenge** (high sensitivity), and a **negative test** is reliable in **ruling out asthma (**high negative predictive value)

Answer 25

In **restrictive lung disease** (ex: intersittial lung disease, obsesity hypoventilation syndrome) **FEV1 and FVC are both decreased**, but fairly **proportionally**, therefore the **FEV1/FVC ratio is normal or increased.**

Answer 26

pulmonary arterial hypertension (due to intimal hyperplasia of the pulmonary arteries) causes **reduced DLCO** due to a combination of impaired blood delivery to the pulmonary capillaries and impaired diffusion of gas across the alveolar-pulmonary capillary membrane. ## Footnote **Lung volumes are typically normal.**

Answer 27

Like asthma, COPD demonstrates an **obstructive** **pattern** on PFT characterized by a **reduced FEV1/FVC ratio.** **DLCO is also reduced** (allowing for **diagnostic differentation from asthma)** due to emphysematous destruction of the alveolar-pulmonary capillary membrane.

Answer 28

**Basal insulin** (glargine, detemir, or NPH) **must be continued in type 1 diabetics** to prevent DKA and severe hyperglycemia. During hospitalization, the **dose of insulin should generally decreased** by **20-30%** because patients are eating less. However, in some patients, the basal insuin **may need to be increased** due to **insulin resistance** caused by **infection, stress, inactivity** and medications such as **corticosteriods**. **Short - acting** insulin analogue (aspart, lispro, or glulisine) every **4 hours** or **regular** insulin **every 6 hours**, **based on glucose readings.** Short acting is **not required if patients are not eating.**

Answer 29

Best eye (E) response (max. 4 points) Best Verbal (V) response (max 5 points) Best motor (M) response (max 6 points) Intubation is recommended for GCS score or = to 8.

Answer 30

**Positive urine HCG, lower abdominal pain and/or vaginal bleeding** **fallopian tubes** Ruptured ectopic pregnancy is a **clinical diagnosis** that is **confirmed during surgery.** **Hemodynamically unstable patients** (ex: hypotension, tachycardia) with **signs of hemoperitoneum** (abdominal rigidity, rebound, guarding) and **adrenxal tenderness,** ruptured ectopic pregancy is diagnosed.

Answer 31

_Unstable_ - Immediate surgical intervention via emergency laparoscopy. _Stable_ - B-hcg levels \<1,500 IU/L can be repeated in 48 hours. In normal pregnancy, the B-hcg levels increses by at least 35% every 48 hours and a intrauterine pregnancy usualy becomes visible on transvaginal ultrasound at b-hcg \> or = to 1,500.

Answer 32

experiencing **sudden-onset abdominal pain** with **significant tenderness and guarding.** Patietns with **peritonitis** tend to **lie still** to minimize peritoneum irritation. An **upgright chest x-ray** showing **pneumoperitonium** can identify perforation. \*it is important to keep the patient in an upright position so that the air within the peritoneal cavity can be visualized underneath the diaphgram.

Answer 33

**rapid progresive weakness** of the **lower extremities** f**ollowing an upper respiratory infection,** accompanied by **sensory loss and urinary retention**

Answer 34

measured at **15-20 weeks gestation** as a screening test for a variety of fetal abnormalities. AFP is **made by the fetus** and excreted from the fetal kidney into the aminoic fluid. Although the function of AFP is unknown, there is an associated between abnormal levels and fetal abnormalities. An **elevated AFP level \< or = 2.5 MoMs)** is frequently associated with **neural** **tube** **defects** (ex: open spinal bidfida, anencepaphly) and **ventral** **wall** **defects** (ex: omphalocele, gastroschisis). Elevated levels should undergo detailed anatomic ultrasound.

Answer 35

experiencing **sudden-onset abdominal pain** with **significant tenderness and guarding.** Patietns with **peritonitis** tend to **lie still** to minimize peritoneum irritation. An **upgright chest x-ray** showing **pneumoperitonium** can identify perforation. \*it is important to keep the patient in an upright position so that the air within the peritoneal cavity can be visualized underneath the diaphgram.

Answer 36

presence of **psychotic symptoms** (not due to substances or a medical condition) for **more than 6 months** _Good prognostic factors:_ **later age of onset,** **acute onset,** **positive psychotic symptoms** (ex: delusions, halluciinations) - *typically responds well to antipsychotic medications*

Answer 37

**V/Q mismatch** The emphysematous component of COPD causes **airflow lmitation** due to loss of elastic tissue and small bronchiolar collapse and chronic bronchitis contributes to airflow limitation as well. The result is numerous localized areas of lung that have a low V/Q ratio, which is the major cause of hypoxemia in patietns with COPD. These **poorly ventilated lung regions** (low V/Q regions) undergo **hypoxic vasoconstriction** to improve overall gas exchange efficiency, but nonetheless still have low V/Q ratio. Despite restricted airflow**, supplemental oxygen** is able to successfully reach the alveoli in these regions, resuling in an **increase in Q** (due to the **alleviation of hypoxic vasoconstriction**) and **improved gas exhang**e to the blood (**improved hypoxemia**)

Answer 38

**Emergency surgery (open or laproscopic) is indicated in all patients.** In preparation for surgery, patients with perforated viscus should receive **fluid resuscitation** and **broad-spectrum IV antiboitics** with good coverage of Gram Neg organisms. **IV PPI therapy** is also suggested for patients with perforated peptic ulcer.

Answer 39

**a.k.a acute colonic pseudo-obstruction** characterized by **dilation of the cecum and right colon in absence of a mechanical obstruction** to the flow of intestional contents.

Answer 40

First step is evaluation for intracranial hemorrhage with **emergency CT scan of the head without contrast.** In patients without intracranial hemorrhage, the next step is restoration of blood flow to the ischemic area. Current guidelines recommend consideration of t**issue plasminogen activator (tPA)** in patients **up to 4.5 hours (optimally first 3 hours)** after the **onset of neurologic symptoms.** After treatment with tPA, patient is monitored in ICU or dedicated stroke unit. **Strict blood pressure management.** Must keep **\<185/105 but \>140/90** to maintain adequate perfusion. Strict BP control is recommended with **IV (not oral) drugs such as labetol, nitroprusside, or nicardipine** to avoid the risk of hemorrhagic transformation.

Answer 41

**Endoscopic ultrasound with aspiration** EUS uses ultrasound guidance of the the endoscope for needle biopsy of lesions too small to be identified by CT/MRI or that are encased by vascular structures (making percutaneous biopsy difficult). EUS is most effective for biospying lymph nodes and lesions in the pancreas, liver, adrenal glad, bile duct, peritoneal fluid and pleural fluid.

Answer 42

Prognosis of less \< or = to 6 months and the patient's willingness to forego life-sustaining treatment. \*If patient is unable to vocalize a choice due to delirium, etc. (and therefore cannot give consent), family members can offer a **substituted judgement** in which they decide for the patient based on what she/he would have wanted under current circumstances. \*Physicians should educate patients and famililes that **full code status**, **co-morbid conditions**, and i**nability to give full informed consent** are **not contraindications** to hospice care.

Answer 43

**Type 1 HIT** occurs due to **nonimmune** direct effect of heparin on platelet activation and usually presents within the **first 2 days of heparin exposure**. The **platelet cound then normalizes** **with continued heparin therap**y and there are **no clincal consequences.** **Type 2 HIT** is a more serious **immune-mediated** disorder due to **antibodies to platelet factor 4 (PF4) complexed with heparin.** This leads to **platelet aggregation, thrombocytopenia, and thrombosis** (both arterial and venous). **Platelet counts usually drop to \< or = to 50% from baseeline with a nadir of 30,000-60,000.** Type 2 HIT usually presents **5-10 days after the initation of heparin therapy** and may lead to l**ife-threatening consequences** (ex: limb ischemia, stroke)

Answer 44

**Tissue factor** and **initiates the blood coagulation cascade.** It is also released in large amounts in **disseminated intravascular coagulation**, which is typically associated with systemic infection (sepsis), malignancy, or obsteric complications.

Answer 45

Protein C is a vitamin K-depedent anticoagulant produced in the liver. **warfarin decreases protein C levels**, leading to a transient hypercoagulable state. Patient needs to be adequately **anticoagulatd for 3 days with heparin** **before the start of warfarin.**

Answer 46

**All forms of heparin (**including LMWH such as enoxparin) **must be stopped immediately** in paitents with suspected HIT while awaiting diagnostic confirmation. Patients with HIT remain at high risk of thrombosis even after discontinuation of heparin. Therefore, an **alternate, rapid acting, non-heparin anticoagulant** such as **direct thrombin inhibitor (ex: argatroban, bivalirudin) must be started immediately.** **Warfarin therapy** alone increases the risk of venous gangrene in patients with DVT due to rapid lowering of protein C levels. It **can be resumed once the patient has been stably anticoagulated using an alternate anticoagulant and the platelet counts have increased \>150,000.**

Answer 47

avoid all forms of heparin (including LMWH) for life. This includes heparin flushes for arterial lines and heparin coated catheters.

Answer 48

ACE inhibitors They reverse the angiotensin-induced vasoconstriction

Answer 49

**Very high glucose** (frequently \>1,000 mg/dL), **mental status changes** and **no associated keotacidosis.** Common causes: infections, major illnesses, dehydration, and drugs such as corticosteriods, psychotics, diuretics, sympathomimentic agents and beta blockers. Inital management of HHS includes **high flow IV fluids**, **continous IV insulin infusion** and **careful potassium replacement.** **Stablized patients can transition to subcutaneous insulin with a basal-bolus regimen.** **Subcutaneous insulin can generally be started once the glucose has been corrected to \<200.** \*Management of DKA and HHS is the same

Answer 50

**Appears at 6-15** **more common in boys** Dx: **multiple motor tics and at least one vocal tic (r**ange from coughing, grunting, throat clearing, sniffing to blurting out inapprpriate comments and obscenitis - coprolalia) **ADHD and OCD** are common

Answer 51

Tourettes has both motor and vocal whereas chronic tic disorder invoves one more motor or vocal (but not both) for \> or = 1 year.

Answer 52

**Includes psychotherapy and/or medications.** **Habit reversal therapy (HRT),** a form of **cognitive-behavioral therapy,** is the most effective nonpharmacological treatment. When tics are severe and interfer with social and academic functioning or if the response to HRT is suboptimal or HRT is not available, pharmacolgical treatments may be required. 1st-generation antipsychotics (fluphenzine, pimozide, halperiodol) have demostrated efficiacy and are approved by the FDA. **However, 2nd generation antipsychotics (risperodone, arpripizole) are typically preferred** due to 1st genration side effects (extrapyramidal symptoms, QtC prolongaiton with pimoizde). Other pharmacological treatment include **alpha-2-aderengeric receptor agonists** (ex: clonidine, guanfacine) and **terabenazine** (a dopamine depleter)

Answer 53

Mild elevation in TSH levels (5-10) accompanied by normal free T4 levels. Treatment is warranted in the presence of: 1. Antithyroid antibodies. 2. abnormal lipid profile 3. symptoms of hypothyroidism 4. ovulatory and menstrual dysfunction

Answer 54

Traumatic lumbar puncture results from accidental damage of a blood vessel during the procedure. A high RBC count without xanthochromia

Answer 55

**Precontemplation** - not ready to change **Contemplation** - thinking of changing **Preparation** - ready to change **Action** - making change **Maintenance** - changes integrated

Answer 56

Patients with no improvement (**nonresponders**) or unacceptable tolerability generally benefit from **switching to another antidepressant.** **Partial responders** who are otherwise tolerating their current antidepressant, **augmentation** is considered **first-line option.** Augumentation strategies include adding a second-generation antipsychotic, an antidipressant with a different mechanism of action, or occasionally lithium or triiodothyronine.

Answer 57

**Bupropion** Norepnephrine dopamine reuptake inihibitor **Does not cause weight gain or sexual side effects** and has been used to **treat SSRI-induced sexual side effects.**

Answer 58

Does not cause sexual dysfunction, but it is associated with increased appetite, weight gain, and sedation

Answer 59

**MAO inhibitor** Risk of **sertotonin syndrome** Reqires a **2-week washout period** (**5 weeks for fluoxetine** due to its longer half life due to the risks of hypertensive crisis or serotonin syndrome

Answer 60

- **does not cause** any major rheumatologic, autoimmune, or neurologic disorder. - Morbidity assocated with local complications, such as **capsular contracture, implant deflation and rupture.** **-Do not cause any disease/defects in developing fetus** **-No evidence of harmful effects in babies who are breastfed by mothers with silicon breast implants** **- Should continue to have screening mammograms at regular intervals**

Answer 61

performed by obtaining a **small sample (few drops) of blood** from the **heel** **pad** and using a piece of filter paper to absorb the blood sample. **Done within 2-5 days following delivery** * \*Performed after first 24 hours because there is a **normal physiologic TSH surge following delivery.*** * Afer the first 24 hours, the TSH levels gradually drop to normal levels or may remain slightly elevated for the next few days.* **Low T4 and elevated TSH levels of the blood sample from heel pad** are suggesitve of primary hypothyroidism Confirm the dignosis by **measuring free T4 and TSH levels** from **regular blood draw before starting levotyroxine therapy.**

Answer 62

**Hyperthyroidism, elevated ESR, enlarged thyroid** **Quervain's thyroiditis or granulomatous thyroiditis** _Subacute thyroidits_ - **painful ;** **mixed inflammatory thyroid infiltrate** consisting of lymphocytes, neutrophils, hisitocytes and multinucelated giant cells. _Silent thyroiditis & Hashmimoto thyroiditis_ - **painless;** pr**edominately lymphocyte infiltration**

Answer 63

**release of stored thyroid hormones** from **inflammatory damage** to thyroid follicles. Patients will have **suppressing TSH**, with resulting **decrease iodine uptake and new thyroid hormone synthesis.** They will have typically **low radioiodine uptake in the thyroid.** Low radioactive idone uptake is also seen in **silent (painless) thyroiditis, postpartum thyroiditis, surreptitious thyroid hormone abuse, and iodine-induced thyroiditis.**

Answer 64

presence of **hyperfunctioning adenoma.** These patients have symptomatic hyperthyroidism but are less likely to have fever or thyroid tenderness and would have nodular enlargement, rather than diffuse enlargement.

Answer 65

common syndrome that is caused by **entrapment of the lateral femoral cutaneous nerve**, which is **purely sensory nerve** that is a **direct branch of the lumbar plexus.** Can be compressed as it coruses from the lumbar plexus, through the abdominal cavity, under the inguinal ligament and into the subcutaneous tissue of the thigh. _Physical examination_ reveals a **decreased sensation over the anterolateral thigh** **without any muscle weakness or deep tendon reflex abnormalities.** **Dx: Clinical** _Common causes_: **Obesity and use of tight garments** around the waist _Management_: **Reassurance** and **conservative** **measures** such as **weight loss** (in obese patients) and **avoid tight fitting clothing** to reduce pressure on the nerve entrapment area.

Answer 66

**Diffusedly increased uptake** in seen in grave's disease due to **anti-thyrotropin receptor autoantibodies that stimuate iodine uptake and thyroid hormone synthesis.** Goiter in Graves is less tender than subacute thyrodiits. **In graves, T3 is more elevated than T4.** In patient with **subacute thyroidits, T4 is more elevated than T3**, reflecting the ratio of T4 to T3 in performed thyorid hormones within the thyroid gland. The normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the hormone "strength" as T4.

Answer 67

**Increase patchy radioiodine uptake** TMG is most common in older patients and thyrotoxic symptoms are generally subtle, if present at all. The thyroid in TMG may appear diffusely enlarged if there are no dominant nodules, but it is usually not tender.

Answer 68

**Self limited condition. Treatment is supportive.** Most cases can be managed with **NSAID to relieve pain**, along with **BB** to **minimize hyperthyriod symptoms.** systemic **corticoidsteroid therapy** \*Thyrotoxicosis in patients with ST is due to release of preformed thyroid hormone. Antithyroid drugs, which work by decreasing synthesis of thyroid hormones are ineffective.

Answer 69

**Child's sudden refusal to move the arm immediately after the forearm was pulled.** Another common mechanism of injury is **swinging of the child by the arms.** **Child hold their arm close to their body with forearm pronated and elbow extended.** **A.k.a nursemaid elbow or annular ligament displacement** Typically occurs in children age **6 months to 5 years.** Sudden pulling force causes the **annular ligament to slide over the radial head** and become **entrapped in the radiohumeral joint.**

Answer 70

**Clinical** **Radiographs are not necessary to make diagnosis** when the history and examination findings are classic - child holds arm close to their body with forearm pronated and elbow eextended. Treatment consists o**f hyperpronation or supination/flexion.** **Hyperpronation method -** child's arm is held at the elbow, pressure is applied to the raidal head and the forearm is hyperpronated. **Supination/flexion methold** - elbow is supported imilarly while the patients forearm is quickly supinated and fully flexed at the elbow in an continuous motion. **Hyperpronation has a significantly higher change of successful** **reduction** than supination, although practitioners may use whatever method they are most comfortable performing. Following reduction, the child should be able to move the arm normally **within a few minutes.**

Answer 71

common syndrome that is caused by **entrapment of the lateral femoral cutaneous nerve**, which is **purely sensory nerve** that is a **direct branch of the lumbar plexus.** Can be compressed as it coruses from the lumbar plexus, through the abdominal cavity, under the inguinal ligament and into the subcutaneous tissue of the thigh. _Physical examination_ reveals a **decreased sensation over the anterolateral thigh** **without any muscle weakness or deep tendon reflex abnormalities.** **Dx: Clinical** _Common causes_: **Obesity and use of tight garments** around the waist _Management_: **Reassurance** and **conservative** **measures** such as **weight loss** (in obese patients) and **avoid tight fitting clothing** to reduce pressure on the nerve entrapment area.

Answer 72

Depends on its severeity **Mild disease** - patients with mild disease, lack of organ failure ad local or systemic complicaitons should undergo **cholecystectomy within 7 days of clincial improvement** (usually during the same hospitalization). *\*Patients who do not have their gallbladders removed have 25-30% risk of recurrent acute pancreatitis, cholecystitis or cholangitis during the next 6-18 weeks.* **Severe disease -** should **delay cholecystectomy** until futher resolution of inflammation and complications.

Answer 73

acute onset of epigastric pain radiating ot the back, N/V and elevated lipase = acute pancreatitis Lack of alcohol use and normal TG and calcium levels, plus evidence of cholelititiasis with elevated of ALP

Answer 74

Physicians with HIV do not need to be reported as long as they do not engage in activities that pose a significant threat to transmission to their patients or members of the medical staff

Answer 75

**Clinical** **Radiographs are not necessary to make diagnosis** when the history and examination findings are classic - child holds arm close to their body with forearm pronated and elbow eextended. Treatment consists o**f hyperpronation or supination/flexion.** **Hyperpronation method -** child's arm is held at the elbow, pressure is applied to the raidal head and the forearm is hyperpronated. **Supination/flexion methold** - elbow is supported imilarly while the patients forearm is quickly supinated and fully flexed at the elbow in an continuous motion. **Hyperpronation has a significantly higher change of successful** **reduction** than supination, although practitioners may use whatever method they are most comfortable performing. Following reduction, the child should be able to move the arm normally **within a few minutes.**

Answer 76

**Child's sudden refusal to move the arm immediately after the forearm was pulled.** Another common mechanism of injury is **swinging of the child by the arms.** **Child hold their arm close to their body with forearm pronated and elbow extended.** **A.k.a nursemaid elbow or annular ligament displacement** Typically occurs in children age **6 months to 5 years.** Sudden pulling force causes the **annular ligament to slide over the radial head** and become **entrapped in the radiohumeral joint.**

Answer 77

A **low dose suppression test** Cushing's can be a **secondary cause of hypertension**. patient would have **obesity, muscle weakness, hyperpigmentation, brusing, or other Cushingoid features.**

Answer 78

A **femoral nerve lesion** causes **anterior and anteromedial thigh paresthesia**, but it is **uncommon.** It is accompanied by **quadriceps muscle wekaness and decreased knee jerk reflex.**

Answer 79

back pain that radiates down the lateral or posterior aspect of the leg. Weakness of the muscle supplied by the corresponding segment is usually present.

Answer 80

sensory loss over the medial thigh and weakness in leg adduction

Answer 81

Likelihood of an **event occuring the treatment group relative to the control** group. **Measure of effect** used in **survival analysis (or time to event analysis)** **Null value for HR is 1.0,** which means there is **no difference in risk** between the two groups. **HR \<1.0 = protective effect** *(event less likely to occur in the treatment group than the control group)* **HR \>1.0 indicates a detrimental effect** *(event more likely to occur in the treatment group than the control group)*

Answer 82

**CPAP** (continous positive airway pressure) is often used when weaning patients from ventilator. It essentially **provides only PEEP without any ventilatory support.**

Answer 83

would help **increase minute ventilation (RR x Vt).** This would be **effective if the patient was ventilating poorly (had a elevated CO2) .** \*Respiratory minute volume (or minute ventilation or minute volume) is the volume of gas inhaled (inhaled minute volume) or exhaled (exhaled minute volume) from a person's lungs per minute. It is an important parameter in respiratory medicine due to its relationship with blood carbon dioxide levels.

Answer 84

Increasing PEEP can **prevent the atelectatic alveoli form collapsing** **during** **expiration**. Many times thre is no way of knowing if a patient has recuritable avlevoli and the effect of PEEP is monitored by **following the** **PaO2/FiO2 ratio.** **PEEP** should be usd with caution, especially in localized lung processes such as pneumonia, because the **increased pressure can be distributed to the normal lung causing alveolar injury.** **PEEP** can also **worsen hypotension** since it **reduces preload.**

Answer 85

**Increasing the FiO2 or increasing the PEEP (**positive end expiratory pressure). **FiO2** and **PEEP** are usually used to regulate **P02.** **Respiratory rate** and **tital volume** correlate with **ventilation**, which is used to regulate CO2.

Answer 86

**Basal insulin** (glargine, detemir, or NPH) **must be continued in type 1 diabetics** to prevent DKA and severe hyperglycemia. During hospitalization, the **dose of insulin should generally decreased** by **20-30%** because patients are eating less. However, in some patients, the basal insuin **may need to be increased** due to **insulin resistance** caused by **infection, stress, inactivity** and medications such as **corticosteriods**. **Short - acting** insulin analogue (aspart, lispro, or glulisine) every **4 hours** or **regular** insulin **every 6 hours**, **based on glucose readings.** Short acting is **not required if patients are not eating.**

Answer 87

**V/Q mismatch** The emphysematous component of COPD causes **airflow lmitation** due to loss of elastic tissue and small bronchiolar collapse and chronic bronchitis contributes to airflow limitation as well. The result is numerous localized areas of lung that have a low V/Q ratio, which is the major cause of hypoxemia in patietns with COPD. These **poorly ventilated lung regions** (low V/Q regions) undergo **hypoxic vasoconstriction** to improve overall gas exchange efficiency, but nonetheless still have low V/Q ratio. Despite restricted airflow**, supplemental oxygen** is able to successfully reach the alveoli in these regions, resuling in an **increase in Q** (due to the **alleviation of hypoxic vasoconstriction**) and **improved gas exhang**e to the blood (**improved hypoxemia**)

Answer 88

Physicians with HIV do not need to be reported as long as they do not engage in activities that pose a significant threat to transmission to their patients or members of the medical staff

Answer 89

sensory loss over the medial thigh and weakness in leg adduction

Answer 90

back pain that radiates down the lateral or posterior aspect of the leg. Weakness of the muscle supplied by the corresponding segment is usually present.

Answer 91

**CPAP** (continous positive airway pressure) is often used when weaning patients from ventilator. It essentially **provides only PEEP without any ventilatory support.**

Answer 92

would help **increase minute ventilation (RR x Vt).** This would be **effective if the patient was ventilating poorly (had a elevated CO2) .** \*Respiratory minute volume (or minute ventilation or minute volume) is the volume of gas inhaled (inhaled minute volume) or exhaled (exhaled minute volume) from a person's lungs per minute. It is an important parameter in respiratory medicine due to its relationship with blood carbon dioxide levels.

Answer 93

Increasing PEEP can **prevent the atelectatic alveoli form collapsing** **during** **expiration**. Many times thre is no way of knowing if a patient has recuritable avlevoli and the effect of PEEP is monitored by **following the** **PaO2/FiO2 ratio.** **PEEP** should be usd with caution, especially in localized lung processes such as pneumonia, because the **increased pressure can be distributed to the normal lung causing alveolar injury.** **PEEP** can also **worsen hypotension** since it **reduces preload.**

Answer 94

**Increasing the FiO2 or increasing the PEEP (**positive end expiratory pressure). **FiO2** and **PEEP** are usually used to regulate **P02.** **Respiratory rate** and **tital volume** correlate with **ventilation**, which is used to regulate CO2.

Answer 95

A **femoral nerve lesion** causes **anterior and anteromedial thigh paresthesia**, but it is **uncommon.** It is accompanied by **quadriceps muscle wekaness and decreased knee jerk reflex.**

Answer 96

acute onset of epigastric pain radiating ot the back, N/V and elevated lipase = acute pancreatitis Lack of alcohol use and normal TG and calcium levels, plus evidence of cholelititiasis with elevated of ALP

Answer 97

Depends on its severeity **Mild disease** - patients with mild disease, lack of organ failure ad local or systemic complicaitons should undergo **cholecystectomy within 7 days of clincial improvement** (usually during the same hospitalization). *\*Patients who do not have their gallbladders removed have 25-30% risk of recurrent acute pancreatitis, cholecystitis or cholangitis during the next 6-18 weeks.* **Severe disease -** should **delay cholecystectomy** until futher resolution of inflammation and complications.

Answer 98

**Self limited condition. Treatment is supportive.** Most cases can be managed with **NSAID to relieve pain**, along with **BB** to **minimize hyperthyriod symptoms.** systemic **corticoidsteroid therapy** \*Thyrotoxicosis in patients with ST is due to release of preformed thyroid hormone. Antithyroid drugs, which work by decreasing synthesis of thyroid hormones are ineffective.

Answer 99

**Increase patchy radioiodine uptake** TMG is most common in older patients and thyrotoxic symptoms are generally subtle, if present at all. The thyroid in TMG may appear diffusely enlarged if there are no dominant nodules, but it is usually not tender.

Answer 100

**Diffusedly increased uptake** in seen in grave's disease due to **anti-thyrotropin receptor autoantibodies that stimuate iodine uptake and thyroid hormone synthesis.** Goiter in Graves is less tender than subacute thyrodiits. **In graves, T3 is more elevated than T4.** In patient with **subacute thyroidits, T4 is more elevated than T3**, reflecting the ratio of T4 to T3 in performed thyorid hormones within the thyroid gland. The normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the hormone "strength" as T4.

Answer 101

presence of **hyperfunctioning adenoma.** These patients have symptomatic hyperthyroidism but are less likely to have fever or thyroid tenderness and would have nodular enlargement, rather than diffuse enlargement.

Answer 102

**release of stored thyroid hormones** from **inflammatory damage** to thyroid follicles. Patients will have **suppressing TSH**, with resulting **decrease iodine uptake and new thyroid hormone synthesis.** They will have typically **low radioiodine uptake in the thyroid.** Low radioactive idone uptake is also seen in **silent (painless) thyroiditis, postpartum thyroiditis, surreptitious thyroid hormone abuse, and iodine-induced thyroiditis.**

Answer 103

**Hyperthyroidism, elevated ESR, enlarged thyroid** **Quervain's thyroiditis or granulomatous thyroiditis** _Subacute thyroidits_ - **painful ;** **mixed inflammatory thyroid infiltrate** consisting of lymphocytes, neutrophils, hisitocytes and multinucelated giant cells. _Silent thyroiditis & Hashmimoto thyroiditis_ - **painless;** pr**edominately lymphocyte infiltration**

Answer 104

performed by obtaining a **small sample (few drops) of blood** from the **heel** **pad** and using a piece of filter paper to absorb the blood sample. **Done within 2-5 days following delivery** * \*Performed after first 24 hours because there is a **normal physiologic TSH surge following delivery.*** * Afer the first 24 hours, the TSH levels gradually drop to normal levels or may remain slightly elevated for the next few days.* **Low T4 and elevated TSH levels of the blood sample from heel pad** are suggesitve of primary hypothyroidism Confirm the dignosis by **measuring free T4 and TSH levels** from **regular blood draw before starting levotyroxine therapy.**

Answer 105

- **does not cause** any major rheumatologic, autoimmune, or neurologic disorder. - Morbidity assocated with local complications, such as **capsular contracture, implant deflation and rupture.** **-Do not cause any disease/defects in developing fetus** **-No evidence of harmful effects in babies who are breastfed by mothers with silicon breast implants** **- Should continue to have screening mammograms at regular intervals**

Answer 106

**MAO inhibitor** Risk of **sertotonin syndrome** Reqires a **2-week washout period** (**5 weeks for fluoxetine** due to its longer half life due to the risks of hypertensive crisis or serotonin syndrome

Answer 107

Does not cause sexual dysfunction, but it is associated with increased appetite, weight gain, and sedation

Answer 108

**Bupropion** Norepnephrine dopamine reuptake inihibitor **Does not cause weight gain or sexual side effects** and has been used to **treat SSRI-induced sexual side effects.**

Answer 109

Patients with no improvement (**nonresponders**) or unacceptable tolerability generally benefit from **switching to another antidepressant.** **Partial responders** who are otherwise tolerating their current antidepressant, **augmentation** is considered **first-line option.** Augumentation strategies include adding a second-generation antipsychotic, an antidipressant with a different mechanism of action, or occasionally lithium or triiodothyronine.

Answer 110

**Precontemplation** - not ready to change **Contemplation** - thinking of changing **Preparation** - ready to change **Action** - making change **Maintenance** - changes integrated

Answer 111

Traumatic lumbar puncture results from accidental damage of a blood vessel during the procedure. A high RBC count without xanthochromia

Answer 112

Mild elevation in TSH levels (5-10) accompanied by normal free T4 levels. Treatment is warranted in the presence of: 1. Antithyroid antibodies. 2. abnormal lipid profile 3. symptoms of hypothyroidism 4. ovulatory and menstrual dysfunction

Answer 113

**Includes psychotherapy and/or medications.** **Habit reversal therapy (HRT),** a form of **cognitive-behavioral therapy,** is the most effective nonpharmacological treatment. When tics are severe and interfer with social and academic functioning or if the response to HRT is suboptimal or HRT is not available, pharmacolgical treatments may be required. 1st-generation antipsychotics (fluphenzine, pimozide, halperiodol) have demostrated efficiacy and are approved by the FDA. **However, 2nd generation antipsychotics (risperodone, arpripizole) are typically preferred** due to 1st genration side effects (extrapyramidal symptoms, QtC prolongaiton with pimoizde). Other pharmacological treatment include **alpha-2-aderengeric receptor agonists** (ex: clonidine, guanfacine) and **terabenazine** (a dopamine depleter)

Answer 114

Tourettes has both motor and vocal whereas chronic tic disorder invoves one more motor or vocal (but not both) for \> or = 1 year.

Answer 115

**Appears at 6-15** **more common in boys** Dx: **multiple motor tics and at least one vocal tic (r**ange from coughing, grunting, throat clearing, sniffing to blurting out inapprpriate comments and obscenitis - coprolalia) **ADHD and OCD** are common

Answer 116

**Very high glucose** (frequently \>1,000 mg/dL), **mental status changes** and **no associated keotacidosis.** Common causes: infections, major illnesses, dehydration, and drugs such as corticosteriods, psychotics, diuretics, sympathomimentic agents and beta blockers. Inital management of HHS includes **high flow IV fluids**, **continous IV insulin infusion** and **careful potassium replacement.** **Stablized patients can transition to subcutaneous insulin with a basal-bolus regimen.** **Subcutaneous insulin can generally be started once the glucose has been corrected to \<200.** \*Management of DKA and HHS is the same

Answer 117

ACE inhibitors They reverse the angiotensin-induced vasoconstriction

Answer 118

avoid all forms of heparin (including LMWH) for life. This includes heparin flushes for arterial lines and heparin coated catheters.

Answer 119

**All forms of heparin (**including LMWH such as enoxparin) **must be stopped immediately** in paitents with suspected HIT while awaiting diagnostic confirmation. Patients with HIT remain at high risk of thrombosis even after discontinuation of heparin. Therefore, an **alternate, rapid acting, non-heparin anticoagulant** such as **direct thrombin inhibitor (ex: argatroban, bivalirudin) must be started immediately.** **Warfarin therapy** alone increases the risk of venous gangrene in patients with DVT due to rapid lowering of protein C levels. It **can be resumed once the patient has been stably anticoagulated using an alternate anticoagulant and the platelet counts have increased \>150,000.**

Answer 120

Protein C is a vitamin K-depedent anticoagulant produced in the liver. **warfarin decreases protein C levels**, leading to a transient hypercoagulable state. Patient needs to be adequately **anticoagulatd for 3 days with heparin** **before the start of warfarin.**

Answer 121

**Tissue factor** and **initiates the blood coagulation cascade.** It is also released in large amounts in **disseminated intravascular coagulation**, which is typically associated with systemic infection (sepsis), malignancy, or obsteric complications.

Answer 122

**Type 1 HIT** occurs due to **nonimmune** direct effect of heparin on platelet activation and usually presents within the **first 2 days of heparin exposure**. The **platelet cound then normalizes** **with continued heparin therap**y and there are **no clincal consequences.** **Type 2 HIT** is a more serious **immune-mediated** disorder due to **antibodies to platelet factor 4 (PF4) complexed with heparin.** This leads to **platelet aggregation, thrombocytopenia, and thrombosis** (both arterial and venous). **Platelet counts usually drop to \< or = to 50% from baseeline with a nadir of 30,000-60,000.** Type 2 HIT usually presents **5-10 days after the initation of heparin therapy** and may lead to l**ife-threatening consequences** (ex: limb ischemia, stroke)

Answer 123

Prognosis of less \< or = to 6 months and the patient's willingness to forego life-sustaining treatment. \*If patient is unable to vocalize a choice due to delirium, etc. (and therefore cannot give consent), family members can offer a **substituted judgement** in which they decide for the patient based on what she/he would have wanted under current circumstances. \*Physicians should educate patients and famililes that **full code status**, **co-morbid conditions**, and i**nability to give full informed consent** are **not contraindications** to hospice care.

Answer 124

**Endoscopic ultrasound with aspiration** EUS uses ultrasound guidance of the the endoscope for needle biopsy of lesions too small to be identified by CT/MRI or that are encased by vascular structures (making percutaneous biopsy difficult). EUS is most effective for biospying lymph nodes and lesions in the pancreas, liver, adrenal glad, bile duct, peritoneal fluid and pleural fluid.

Answer 125

First step is evaluation for intracranial hemorrhage with **emergency CT scan of the head without contrast.** In patients without intracranial hemorrhage, the next step is restoration of blood flow to the ischemic area. Current guidelines recommend consideration of t**issue plasminogen activator (tPA)** in patients **up to 4.5 hours (optimally first 3 hours)** after the **onset of neurologic symptoms.** After treatment with tPA, patient is monitored in ICU or dedicated stroke unit. **Strict blood pressure management.** Must keep **\<185/105 but \>140/90** to maintain adequate perfusion. Strict BP control is recommended with **IV (not oral) drugs such as labetol, nitroprusside, or nicardipine** to avoid the risk of hemorrhagic transformation.

Answer 126

**a.k.a acute colonic pseudo-obstruction** characterized by **dilation of the cecum and right colon in absence of a mechanical obstruction** to the flow of intestional contents.

Answer 127

**Emergency surgery (open or laproscopic) is indicated in all patients.** In preparation for surgery, patients with perforated viscus should receive **fluid resuscitation** and **broad-spectrum IV antiboitics** with good coverage of Gram Neg organisms. **IV PPI therapy** is also suggested for patients with perforated peptic ulcer.

Answer 128

presence of **psychotic symptoms** (not due to substances or a medical condition) for **more than 6 months** _Good prognostic factors:_ **later age of onset,** **acute onset,** **positive psychotic symptoms** (ex: delusions, halluciinations) - *typically responds well to antipsychotic medications*

Answer 129

measured at **15-20 weeks gestation** as a screening test for a variety of fetal abnormalities. AFP is **made by the fetus** and excreted from the fetal kidney into the aminoic fluid. Although the function of AFP is unknown, there is an associated between abnormal levels and fetal abnormalities. An **elevated AFP level \< or = 2.5 MoMs)** is frequently associated with **neural** **tube** **defects** (ex: open spinal bidfida, anencepaphly) and **ventral** **wall** **defects** (ex: omphalocele, gastroschisis). Elevated levels should undergo detailed anatomic ultrasound.

Answer 130

**rapid progresive weakness** of the **lower extremities** f**ollowing an upper respiratory infection,** accompanied by **sensory loss and urinary retention**

Answer 131

_Unstable_ - Immediate surgical intervention via emergency laparoscopy. _Stable_ - B-hcg levels \<1,500 IU/L can be repeated in 48 hours. In normal pregnancy, the B-hcg levels increses by at least 35% every 48 hours and a intrauterine pregnancy usualy becomes visible on transvaginal ultrasound at b-hcg \> or = to 1,500.

Answer 132

**Positive urine HCG, lower abdominal pain and/or vaginal bleeding** **fallopian tubes** Ruptured ectopic pregnancy is a **clinical diagnosis** that is **confirmed during surgery.** **Hemodynamically unstable patients** (ex: hypotension, tachycardia) with **signs of hemoperitoneum** (abdominal rigidity, rebound, guarding) and **adrenxal tenderness,** ruptured ectopic pregancy is diagnosed.

Answer 133

Best eye (E) response (max. 4 points) Best Verbal (V) response (max 5 points) Best motor (M) response (max 6 points) Intubation is recommended for GCS score or = to 8.

Answer 134

Like asthma, COPD demonstrates an **obstructive** **pattern** on PFT characterized by a **reduced FEV1/FVC ratio.** **DLCO is also reduced** (allowing for **diagnostic differentation from asthma)** due to emphysematous destruction of the alveolar-pulmonary capillary membrane.

Answer 135

pulmonary arterial hypertension (due to intimal hyperplasia of the pulmonary arteries) causes **reduced DLCO** due to a combination of impaired blood delivery to the pulmonary capillaries and impaired diffusion of gas across the alveolar-pulmonary capillary membrane. ## Footnote **Lung volumes are typically normal.**

Answer 136

In **restrictive lung disease** (ex: intersittial lung disease, obsesity hypoventilation syndrome) **FEV1 and FVC are both decreased**, but fairly **proportionally**, therefore the **FEV1/FVC ratio is normal or increased.**

Answer 137

**Pulmonary function testing (PFT)** Patients with **active** **symptoms** at the **time of testing** should reveal the characteristic **obstructive** pattern consistening of a **reduced FEV1** and a **reduced FEV1/FVC ratio** (total lung capacity and difffusing capacity of the lungs for carbon monoxid (DLCO) are typically normal or sometimes elevated). In these patients, a **bronchodilator** (ex: albuterol) can be administered and should result in **signifcant improvement in FEV1** (ex: 15% from baseline) Those without active symptoms: are likely to have **normal PFT findings.** The administration of **methacholine** in these patients is likely to cause \> or =**20% reduction in FEV1,** which is **diagnostic of airway hyperresponsiveness.** Most patients with asthma have a **positive methacholine challenge** (high sensitivity), and a **negative test** is reliable in **ruling out asthma (**high negative predictive value)

Answer 138

Caused by translocation of **chromosome 9 and 22**, which produces the Philadelphia chromosome. The presence of **bcr/abl fusion protein** is diagnostic of CML and results in **unregulated tyrosine kinase activity.**

Answer 139

**Tyrosine kinase inhibitors** such as **imatinib** are the **inital** treatement of choice in almost all instances. **Later BMT** can be offered to patients who are **young with stable diase and who have a suitable donor.**

Answer 140

chronic auto-inflammatory disorder, presents with **symmetric joint pain, swelling and stiffness involving multipe joints.** Although the diagnosis si clinical, lab evaluation often shows an **elevated ESR, leukocytosis and normocytic anemia of chronic disease.**

Answer 141

**Organisms on the gram stain of synovial fluid are expected** in **septic arthritis** which presents acutely with **fever, joint pain,** and significantly **restricted active and passive range of motion.** ## Footnote **Effusions due to JIA are noninfectious.**

Answer 142

**Tinea capitis** is a dermatophytosis that causes scaly, erythematous patches of the scalp with hair loss. First line treatment is **ORAL griseofulvin or ORAL terbafine.** *Although topical terbinafine is effective against dermatophyte infections of the skin (ex: tinea corporis), an **oral agent must be used to penerate the hair follicles..***

Answer 143

Alopectia areata is an **immune-mediated disease**, characterized by **smooth areas of hair loss (tinea capitis causes scaly erythematous patches on the scalp)** and is treated with topical or intralesional corticosteriods (ex: triamcinolone). **Scaling and erythema is not seen and pruritis is uncommon.** **Topical corticosteriods** are also indicated in the treatement of eczema, which presents with dry, pruritic, erythematous patches,. Distribution can also involve the scalp in infants, but eczema typically affects flxural areas (ex: antecubital fossa) in older children and is not associated with hair loss.

Answer 144

Because nail dystrophies caused by other diseases (ex: psoriasis, lichen planus) can mimic the appearance of onychomycosis, confirmation with **potassium hydroxide (KOH) preparation or culture of nail scapings** is recommended. **Terbinafine** is the preferred first line therapy (finger infection is six weeks, toenails is 12 weeks)

Answer 145

ex: labatory test, biomarker, physical finding are meant to substitute for clinically meaningful endpoints and are typically validated and used in multiple sutdies. Examples include CD4 cell count (surrogate for HIV complications) and hemglobin A1c levels (surrogate for diabetes complications). Resucue inhaler use is commonly used as a surrogate for asthma control

Answer 146

ESRD, von Willebrand disease and aortic stenosis

Answer 147

cherry-red lesions

Answer 148

lung, colon and ovarian cancers

Answer 149

ulcerative colitis

Answer 150

UC or crohn disease

Answer 151

Carcinoid syndrome

Answer 152

unstable patietns with signs of peritonitis or organ evisceration. Stable pateints may be evaluated with nonoperative methods folllowed by surgical evaluation

Answer 153

anterior slippage of the vertebral body, usually in the lower lumbar vertebrae. The raidographic finding of a 'collar on the neck of the Scotty dog' is typical.

Answer 154

surgical repair. due to risk of incarceration adn stragulation.

Answer 155

secondary casues such as Multiple myeloma which can present as rapidly progressive generalized bone loss. They have increased circulatory levels of osteoclast activating factor (OAF) secreted by neopalstic cells.

Answer 156

**caused by trypanosoma cruzi** leading cause of **dilated cardiomyopathy** in Central and South America The **presence of L.V. apical aneurysm** in the **absence of coronary disease** is pathognomonic for Chagas cardiomyopathy. Other findings include complete heart block and ventricular tachycardia. **Progressive dilation of esophagus & Colon**

Answer 157

Borreliosis or Lyme disease is a tick-borne illness caused by an infection with the spirochete Borrelia Burgdorferi. **Lyme carditiis** usually manifests as varying degrees of **AV conduction block.** In rare cases, patietns can also develop myopericarditis with dilated cardiomyopathy. However, **apical aneurysms are not typically seen in patients with Lyme cardidits.**

Answer 158

**TCA, duloxetine or certain anticonvulsant medications (gabapentine, pregabalin)** can alter neuronal tranmission and decrease pain. While TCA are effective for pain control for diabetic neuropathy, **SSRI's are not.**

Answer 159

**Acute PE is estimated to cause a fever in approx 15% of cases;** therefore fever in these patietns is **not an indication for antibiootics** in **the absence of other evidence of infection (**ex: consolidation on CSR, incisional purulence, peripheral line erythema, abnormal urinalysis.

Answer 160

**autosomal dominant** disorder due to inactivating mutations on the calcium-sensing receptor. Patients with FHH have **mild hypercalcemia without any clnical findigns** and **do not require treatment.**

Answer 161

**Patients (and family members) with MEN types 1 and 2A** may present with **hypercalcemia** due to **primary PTH.** However, they are **less likely** than patients with FHH **to follow a benign course** and usually have additional features. **MEN 1** also causes **pituitary tumors** (ex:visual field defects) and **enteropancreatic neuroendocrine tumors,** whereas **MEN2A** also causes **medullary thyroid cancer** (paplable neck mass) **and pheochromocytoma.** **FHH does not affect the pituitary gland or cause palpage parathyroid findings.**

Answer 162

tends to be activating and is more prone to cause insomnia and jitteriness. Switch to another SSRI that is less likely to cause insonomia nd itterniess such as escitalopram.

Answer 163

**Pernicious anemia.** Vitamin B12 deficiency in perncious anemia is due to deficiency of intrinsic factor secreted by the stomach. Dietary Vit B12 binds to the IF secreted by the parital cells in the gastric mucosa. The IF-Vitamin B12 completx is then carried to the terminal ilieum for receptor mediated absorption. Perncious anemia **results from autommune description of parietal cells leading to achlorhydria and decreased production of the IF.** The lack of IF leads to Vitamin B12 def. The RBCs are maycrocytic due to ineffective erythropioesis secondary to defective nucleic acid syntheis. **Neurologic involvement** in Vit. B12 is characterized by subacute combined deneration of the spinal cord ()posterior and lateral columns of the spinal cords) and peripheral neuropathy.

Answer 164

severe hypokalemia. Results from the uptake of potassium by newly forming red blod cells. Close monoring and supplementaiton of potassium is required during this period.

Answer 165

= or \< 60% \*LVEF \> 50 is considered normal in most patients; however in patietns iwth severe chornic primary MR the above LVEF is consistenet with abnormal LV systtolic function.

Answer 166

**Herald patch** pruritic 2-10 cm pink/tan colored lesion which usually appears on the back and is an early sign of pityriasis rosea. Within several days, numerous similar but smaller lesions are usuallly seen.

Answer 167

excisional biopsy to include the entiere lesion with 1-3 mm margins of the surrounding skin and subcutaneous fat.

Answer 168

Referral for social skills training Negative symptoms in schizophrenia cause significant functional impairement and respond poorly to antipsychotic medicaiton. \*Negative symptoms (ex: alogia, flat affect, amotivation, social withradwal)

Answer 169

**risk of severe hepatotoxicty with PTU.** **PTU** is preferred if hyperthyroidism is diagnosed in the **first trimester of pregnancy** as methimazole is associated with more severe terogenic effects.

Answer 170

abnormal formation of the hip joint that **prevents the femoral head from seating probperly in the acetbullum.** **female gender, breech delivery and positive family history** **Barlow test,** which attempts to dislocate an unstable hip. Treatment is overseen by an **orthopedic surgeon.**

Answer 171

**Parinaud's syndrome**, which is charaterized by the **loss of pupillary reaction, vertical gaze peralysis and loss of optokinetic nystagmus and ataxia.** **Some** pineal tumors are **germinomas** that **can secrete HCG**. and cause precoisous pubery in prepubertal males.

Answer 172

Inverse of Absolute risk reduction ARR = Control group event rate - experimental group event rate NNT = 1/ARR

Answer 173

**medial longitudinal fasciculus**, which leads to **internuclear opthalmophlegia.** **Bilateral or unilateral optic neuritis** can occur.

Answer 174

diabetes insipidius and a deficiency of one or more anterior pituitary hormones.

Answer 175

with suprasellar extension can casue **bitemporal hemianopsia.** Patients with pituitary tumors can present with **hormonal dysfuction**, depending on the secretory state and size of the tumor.

Answer 176

**coronary artery disease** (even with a normal lipid profile) and progression to overt diabetes. Fasting glucose levels below 100 are considered normal.

Answer 177

venous blood draw for patients with levels \> or = 45. levels \<45 require close follow up testing and removal of the child from the hazardous envirnoment (ex: home built before 1978)

Answer 178

**CNS catastrophe of known etiology** with an **absence of confounding factors** (ex: endocrine or electrolyte disturbances, drug intoxication) or **hypothermia.** **Neurologic examination** to document absent cortical and brainstem function (ex: coma, absent motor response to pain, absent pupillary light reflex, absent corneal and oculocephalic reflexes and absent gag reflex) **Apnea testing** is the diagnosis of brain death in patients meeting htis criteria.

Answer 179

**Alopecia areata** is characterized by **smooth** and discrete areas of complete hair loss. There is **no associated scaling, scarring or inflammation.** **Tinea capitis** have associated **scaling and inflammation** of the scalp in the areas of hair loss.

Answer 180

Topical or intralestional corticosteriods

Answer 181

characterized by **normal coagulation factors** and **isolated thrombocytopenia** without any obvious etiology. Due to **antiplatelet autantibodies that remove circulating platelets,** which are most often directed against membrane proteins (ex: GPIIb/IIIa) \*Circulating platelets are rpaidly removed by autoantibodies, limiting the role of platelet transfusions.

Answer 182

**DIC** is a consumptive coagulopathy (leading to both **bleeding and thrombosis**) susually asocaited with sepsis, trauma, maligancy or obsteric complications. DIC typically casues an **elevated D-dimer** (due to accelerated fibrinolysis), **prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)** due to depletion of clotting factors), often **with low fibrogen** (due to consumption). **ITP- has normal D-dimer, PT, and aPTT**

Answer 183

Thrombotic thrombocytopenic purpura is characterized by **thrombocytopenia and microangiopathic hemolytic anemia**, which manifests as **schistocytes on peripheral smear** and **elevated lactate dehydrogenase.** Other faeactures may include acute renal failure, fever and neuroligca abnormalties.

Answer 184

**platelets \>30,000 without bleeding** can generally be **observed** without treatment. **Corticosteriod therapy** is a first line treatment option for **ITP in adults with platelets \<30,000 or with bleeding.**

Answer 185

every 2 years for women age 50-75 but can be considered for women age 40-49 and \>75 based on risk factors. Breast cancer screening is not indicated for low risk women \<40.

Answer 186

Odds ratio = (A/C) / (B/D) manipulated into (A\*D)/(B\*C)

Answer 187

Asymptomatic patietns can be observed clinically, as the condition usually resolves within the first 24 hours of life; however, those with clinical symptoms require treatment. Inital treatment consists of hydration and correction of hypoglycemia. If first line treatment is ineffective, an alternative management strategy is partial exchagne transfusion.

Answer 188

**Quality-adjusted life years (QALYs)** and **disability-adjusted life years (DALYs)** **Time-trade-off** is commonly usedfor **QALY calculation** **years of life lost and years lived with disability** are used for **DALY calculations.**

UWORLD 6 Flashcards

(220 cards)