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Uworld questions > Uworld deck 1 > Flashcards

Uworld deck 1 Flashcards

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1
Q

What is req for dx of Type II DM?

A

a) fasting gluc >126, b) random gluc > 200 & sx of hyperglyc, c) 2 hrd GGT > 200

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2
Q

What is impaired fasting glucose?

A

Fasting glucose 100-125, in between state between normal and DM.

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3
Q

How tx impaired fasting glucose or impaired GGT?

A

tx with lifestyle changes, diet, exercise

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4
Q

When is metformin contraindcated?

A

Dont use if renal insufficiency, Cr>1.4. Can lead to worsening lactic acidosis

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5
Q

How tx hospitalized pt with DM II?

A

Tx w/ basal + bolus insulin using long acting insulin (lantus, novolog) and short acting (reg insulin)

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6
Q

How tx diabetic retinopathy?

A

laser ablation w/ pan retinal photocoag

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7
Q

How does diabetic retinopathy px?

A

px w/ non prolif w/ hard exudates, microaneurysms, minor hemorrhages + cotton wool spots of neovascularization. Can lead to retinal detachment + vision loss.

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8
Q

What is optimal basal insulin tx?

A

Should be peakless, 24 hr duration. Includes Lantus and Novolog

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9
Q

Best tx for hyper and hypo episodes?

A

If having many episodes of either, do basal/bolus regimen w/ lantus and novolog, shouldn’t have peaks and troughs with this.

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10
Q

How best manage HHS?

A

1) replinish IV volume w/ fluids, 2)once volume replete start Insulin GGT, 3)Cont drip till Gluc=250.

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11
Q

How manage blood sugars in DKA?

A

use insulin drip, not SQ

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12
Q

How do xanthomas appear?

A

yellow, orange, reddish, brown papules, nodules. If on eyelid then xanthelasma

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13
Q

How manage isolated low HDL?

A

tx with lifestyle modifications. No meds

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14
Q

What is considered HLD?

A

Total fasting chol>200, LDL goal varies based on risk fx

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15
Q

What are LDL goals?

A
  • 0 - 1 risk fx goal <160
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16
Q

How tx high cholesterol and high TGs?

A

use fibrates if TG>200 + elevated non HDL cholest.

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17
Q

What is colestipol?

A

colestipol and cholestyramine are bile binding resins that block absorption leading to decreased LDL

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18
Q

LDL goal if hx of TIA/stroke?

A

LDL < 100

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19
Q

How diagnose hypothyroidism?

A

Can diagnose based on labs and sx. Don’t need to ID any stimulating or inhibitory thyroid Ab.

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20
Q

How manage hypoythyroidism in pregnancy?

A

Need ot do repeated TSH and Total T4, free T4 can be misleading due to increased protein binding lipids in serum.

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21
Q

How tx Graves disease?

A

atenolol + methimazole. Can also use radioactive I- for first line.

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22
Q

CV si/sx of thyrotoxicosis?

A

tachy, htn (esp elevated systolic), widened pulse pressure, lid retrxn.

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23
Q

How workup adrenal incidentaloma?

A

Get plasma metanephrines levels and overnight dexamethasone suppression test.

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24
Q

Diagnostic findings for hyperaldosterone

A

aldo/renin ratio >20:1

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25
What is stress level dosing of steroids required?
should be 10 x normal dose
26
When is pneumococcal vacc indicated?
use when 65 or older. Give second shot 5 years after.
27
When do DEXA scan?
Indicated in all WOMEN > =65 y/o. Can do earlier if high risk.
28
How tx osteoporosis?
first do oral bisphosphonates. If cannot tolerate due to pill esophagitis can do IV zolendronate shots.
29
What is raloxifene?
Selective Estrogen Receptor modulator.
30
Cause of meningitis in neonates?
GBS, Listeria, E coli
31
Cause of meningitis in 3mo-18 y/o?
N. mening, Strept pneumo, H. influe
32
Cause of meningitis in adults (<50)?
Strept Pneumo, N. mening, H. influ
33
Cause of meningitis in elderly?
S. pneumo, N. mening, L. monocytogenes
34
Cause of meningitis in immunocomp?
L. mono, G- rods, S. pneumo
35
How tx meningitis?
Begin ABX immediately after LP findings. Tx empirically until can narrow based on gram stain. Also use steroids if concerned about swelling.
36
Close contacts receive what for meningitis?
Get dose of rocephin or rifampin
37
Usual cause of encephalitis?
Usually viral: arbovirus (Eastern Equine, West Nile) Enterov, polio. Can also be non viral- toxo, cerebral aspergillosis
38
CD4 count at risk for toxo?
If CD4 < 200
39
How dx viral enceph?
LP for CSF - > leukocytosis, can do PCR for viral DNA, MRI to r/o masses, frontotemporal enhancement as seen in HSV
40
How diff types of viral Hep xmitted?
A & E xmitted fecal-oral, B is parenteral or sexual, C is parenteral, D requires BsAg.
41
What are si/sx of viral hep
jaundice, dark urine (conj bili only), RUQ pain, N/V, fvr, malaise, LFTS>500.
42
What are possible complications of hepatitis?
can get hepatic enceph, bleeding diasthesis (uremic platelets), hepatorenal syndrome
43
What is significance of HBeAg?
If present, then patient is infective.
44
What is only antigen present during window period?
Only have Hbcore antigen.
45
LFT patterns in viral hep?
ALT>AST, ALT commonly >1000 in acute cases
46
How tx chronic HBV?
IFN-alpha or lamivudine
47
How tx chronic HCV?
IFN-a or ribavirin
48
How tx botulism?
admit and monitor respiratory state, do GI lavage if ingestion w/in last 2 hours, give toxoid after specimen ID'ed.
49
Most common UTI causes?
E. coli, S. saprophyticus, enterococcus, less commonly proteus, klebs, enterobacter, P.A.
50
What is considered asx bacteriuria?
2 succesive + cultures (>10^5 cfu) w/out sx.
51
What are si/sx of UTI?
dysuria, polyuria, urgency, gross hematuria can be px
52
How confirm UTI dx?
requires urine cx, if sx w/ 10^2-10^4 cfu, then + for UTI
53
What is considered complicated UTI?
any UTI that spreads beyond bladder, or that is due to structural or fxnl problem
54
Tx options for uncomplicated UTI?
Bactrim for 3 days, nitrofurantoin for 5-7 days, fosfamycin X 1 dose, cipro x 3 days
55
How tx prego w/ UTI?
ampicillin, amoxicillin, or cephalosporin x 7-10 days
56
How manage recurrent UTI?
need to do U/S to r/o structural cause, cont ABX x 2 weeks & do urine Cx to determine cure
57
Bugs most freq causing pyelo?
E. Coli, proteus, klebs, enterobact, P.A., also G+s like entero, S. Aeurus
58
UA findings with Pyelo?
Pyuria, bacteriuria, leukocyte casts
59
How tx pyelo?
bactrim or levaquin x 10-14 days if G-rods, Amox if G+ cocci. Can adjust based on cxs after initial empiric tx
60
Si/sx of diphenhydramine posioning?
anti-cholinergic sx, drowsiness, confusion
61
What are some anticholinergic sx?
dry mouth, dilated pupils, blurred vision, dcrsd bowel sounds, urinary retention
62
How tx diphenhydramine OD?
tx w/ physostigmine (cholinesterase inhibitor)
63
What is most common cause of death after MI?
complex vent arrythmias due to reentry arrhthmias
64
What is risk w/ digoxin toxicity?
glyocside intox leads to incrsd ventric automaticity
65
Earliest finding of Diabetic renal damage?
glomerular hyperfiltration --- first sign of renal DM involvement, leads to later DM glomerular disease
66
When tx primary adnrelalism w/ meds?
If bilateral hyperplasia or if unilateral but not surgical candidate
67
What is typical px of acute hemolytic xfusion rxn?
occurs in 1st hr after xfusion, fvr, flank pain, hemoglobinuria, renal failure, DIC, due to ABO incompatibiltiy
68
What is IgA anaphylaxis px in infusion?
occurs in seconds to minutes + px w/ angioedema, hypotension, dyspnea --- LOC, resp failure
69
Signs on ecg of 3rd degree heart block?
no assoc btwn QRS and P wave. P waves occur at rate of 90-120, QRS occur @ rate of about 30 bpm.
70
How tx 3rd degree heart block?
pacemaker placement
71
Si/sx of pulmo infrxn due to P/E?
prolong immobility, hemopytsis, dyspnea, tachy, chest pain w/ inspiration (pleuritic pain)
72
What is risk w/ OCP use?
incrsd risk of thromboembolic event
73
What is result of excess NSAID use on kidneys?
can get papillary necrosis, tubulointerstitial nephritis, px w/ polyuria and sterile pyuria
74
How does acute/chronic GMN px?
hematuria, RBC casts, edema, htn, proteinuria
75
What is cause of immune thrombocytopenia?
platelet destrxn due to IgG Ab against platelet membrane glycoproteins
76
What is bernard Soulier syndrome?
AR defect on platelet glycoprotein --- mild dcrs in platelets, giant platelets on smear, svrr platelet dysfxn, bleeding out
77
Electrolyte abnm w/ legionella pneumonia?
can get hypoNa (only seen in this pneumonia), can also see incrsd LFTs
78
What prolongs survival in COPD?
long term supplemental O2 therapy the major cause of improvement. Beta agonist important in tx too for exacerbations.
79
What is risk fx w/ amitryptilione and other TCAs?
can get urinary retention due to anticholinergic side effect
80
How does urinary retention resent?
Abd pain w/ midline tenderness below umbilicus
81
What bugs typically cause aspiration pneumonia px due to impaired cough reflex?
aerobic oral flora (viridians strept) and anaerobes
82
What is greatest risk fx for SCC of skin?
sunlight exposure
83
What is erysipelas?
type of cellulitis px w/ priminent swelling w/ demarcated border, tender skin lesion
84
WHat bug causes contact-lens associated keratosis?
pseudomonas and serratia. CAn also be due to G+ or fungi
85
What is episcleritis?
red eye w/ patchy distribution, mild pain, no vision abnormalities
86
What is risk of TPN? How manage?
hyperosmolar fluid can damage veins leading to thrombosis. If occurs, 1st remove catheter, short term of anticoag until resolves
87
Where do pressure ulcers most often occur?
usually on boney prominences esp at risk if patient immobile.
88
When are beta blockers contraindicated following MI?
if pt has subsequent decomp HF and pulmo edema
89
Si/sx of liver failure?
telangiectasia, caput medusa, gynecomastia, terry nails, clubbing
90
Prereqs for brain death?
need clinical/ radiologic signs of brain death w/ no evidence of drug/ ETOH intox, core temp must be >32, brain death must be confirmed by 2 docs
91
Si/sx of tropica sprue?
chronic diarrhea --- defic folate, B12 --- MCV>100, glossitis, cheilosis, cramps, gas, weight loss
92
CXR signs of Booerhaves?
widened mediastinum with unilateral pleural effusion
93
What is effect of hypovolemic hemorrhage shock on CO?
dcrsd preload leads to dcrsd CO
94
What is contraindication to succinocholine use?
hyperK --- drug causes signif K release leading to arrhythm. includes pts w. crush injuries, pts w. demyelinatng syndrome (GBS), tumor lysis syndrome
95
First test to confirm suspicion for DKA?
FSBS to determine
96
Serious complication of aortic dissection?
can lead to cardiac tamponade
97
What is problem w. extensive Beta agonist use?
dries K into cells and can lead to significant hypoK
98
Signs of hyperestrogenism in men?
palmar erythema, spider angiomata, gynecomastia, testicular atrophy, dcrsd body hair
99
What is cause of asterixis?
hyperammonemia 2/2 to liver failure
100
Most common cause of osteomyelitis following puncture wound?
most often pseudomonas. If bone not involved more likely staph

Uworld questions (13 decks)

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